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General NPI Number Information
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NPI Number | 1306765763
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Entity Type | Organization
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Legal Business Name | BRIGHT MINDS GROUP HOME LLC
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 07/10/2026
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Provider Practice Location Address
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Address Line | 636 SE STOW TER
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-6452
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Country | US
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Telephone | 561-821-1012
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Fax |
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Provider Business Mailing Address
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Address Line | 636 SE STOW TER
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-6452
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Country | US
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Telephone | 561-821-1012
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | GARY DUNKLEY
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Credential |
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Telephone | 561-821-1012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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