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NPI Code Detail

MEDICARE: BRIGHTER HOPE, LLC

MEDICARE: BRIGHTER HOPE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst100328KY

General Provider Information

NPI Number : 1093255291
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGHTER HOPE, LLC
Provider Business Mailing Address
First Line : PO BOX 516
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40066-0516
Country : US
Telephone Number : 502-633-1315
Fax Number : 502-633-1316
Provider Business Practice Location Address
First Line : 998 BROOKS INDUSTRIAL RD
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40065-8154
Country : US
Telephone Number : 502-633-1315
Fax Number : 502-633-1316
Authorized Official
Title or Position : LLC MEMBER
Name : KYLE STEPHENS
Credential : LBA, BCBA
Telephone Number : 502-633-1315
Provider Enumeration Date : 03/07/2017
Last Update Date : 03/07/2017

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