=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255015830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTER OUTLOOK INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2023
-----------------------------------------------------
Last Update Date | 06/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8029 W MARION ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53222-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-720-0203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5219 W HOWARD AVE APT 1
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53220-2067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-915-3819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CARE COORDINATOR/CO-OWNER
-----------------------------------------------------
Name | SOMER D DEBERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-720-0203
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------