=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952014755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTER CARE ADULT DAYCARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2022
-----------------------------------------------------
Last Update Date | 09/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 AVENUE A STE 100
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34950-4260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-828-3045
-----------------------------------------------------
Fax | 772-302-3807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 AVENUE A STE 100
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34950-4260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-828-3045
-----------------------------------------------------
Fax | 772-302-3807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWN/MANAGER
-----------------------------------------------------
Name | MRS. SHANTELL WALKINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-828-3045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------