MEDICARE: BRIGHT FUTURE RECOVERY 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	324500000X	Substance Abuse Rehabilitation Facility	C031420315	CA

General Provider Information

NPI Number	:	1336520360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT FUTURE RECOVERY INC.

Provider Business Mailing Address
First Line	:	785 QUAIL HOLLOW DR
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-8910
Country	:	US
Telephone Number	:	831-245-7736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 FAIRVIEW RD
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-9644
Country	:	US
Telephone Number	:	831-245-7736
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHEREE DAVILA
Credential	:	RAS, CADC-CAS
Telephone Number	:	831-245-7736

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/16/2015

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