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General NPI Number Information
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NPI Number | 1467151407
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Entity Type | Organization
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Legal Business Name | BRIGHT FUTURE STARS
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 1547 5TH AVE S
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City | SOUTH SAINT PAUL
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State | MN
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Zip | 55075-3453
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Country | US
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Telephone | 952-688-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 5TH AVE S
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City | SAINT PAUL
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State | MN
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Zip | 55075-3453
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FREWEINI SIUM
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Credential |
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Telephone | 952-688-3990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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