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General NPI Number Information
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NPI Number | 1558641472
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Entity Type | Organization
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Legal Business Name | A BRIGHTER CHOICE
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 1309 PORTA ST APT 805
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City | FORT WORTH
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State | TX
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Zip | 76120-4109
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Country | US
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Telephone | 214-707-9387
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14167
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City | ARLINGTON
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State | TX
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Zip | 76094-1167
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Country | US
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Telephone | 214-707-9387
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MS. EDWINA LEIGH SMITH
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Credential |
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Telephone | 682-472-4680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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