MEDICARE: BRIGHTER FUTURES, INC.

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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	12483	UT
2	253J00000X	Foster Care Agency	16265	UT

General Provider Information

NPI Number	:	1093920613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER FUTURES, INC.

Provider Business Mailing Address
First Line	:	6138 S 380 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6988
Country	:	US
Telephone Number	:	801-878-0191
Fax Number	:

Provider Business Practice Location Address
First Line	:	6138 S 380 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6988
Country	:	US
Telephone Number	:	801-878-0191
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHARLES HOSEA
Credential	:
Telephone Number	:	801-878-0191

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	06/09/2010

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