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General NPI Number Information
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NPI Number | 1962058024
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Entity Type | Organization
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Legal Business Name | BRIGHT LANTERN HOME CARE
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 14 POWSLAND ST APT 2
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City | PORTLAND
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State | ME
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Zip | 04102-2622
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Country | US
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Telephone | 808-989-2921
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Fax |
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Provider Business Mailing Address
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Address Line | 14 POWSLAND ST APT 2
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City | PORTLAND
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State | ME
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Zip | 04102-2622
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Country | US
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Telephone | 808-989-2921
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ERIC TUYISHIMIRE
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Credential |
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Telephone | 808-989-2921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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