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General NPI Number Information
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NPI Number | 1841611464
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Entity Type | Organization
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Legal Business Name | BRIGHT LIFE FARMS, INC
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 12/27/2013
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Provider Practice Location Address
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Address Line | 10200 FARMERSVILLE RD
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City | PRINCETON
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State | KY
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Zip | 42445-5340
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Country | US
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Telephone | 270-365-0830
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Fax | 270-365-0830
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Provider Business Mailing Address
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Address Line | 6773 US HIGHWAY 62 W
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City | KUTTAWA
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State | KY
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Zip | 42055-5607
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Country | US
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Telephone | 270-388-6101
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Fax | 270-388-6101
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ROBERTA KNOTH ROBERTSON
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Credential |
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Telephone | 270-388-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 850066
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 850082
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 850070
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License Number State | KY
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