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NPI Code Detail

MEDICARE: SOUTH BAY BRIGHT FUTURE, INC.

MEDICARE: SOUTH BAY BRIGHT FUTURE, 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1336686229
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH BAY BRIGHT FUTURE, INC.
Provider Business Mailing Address
First Line : 24404 VERMONT AVE
Second Line : SUITE 201
City : HARBOR CITY
State : CA
Zip : 90710-2313
Country : US
Telephone Number : 310-891-0096
Fax Number : 310-891-0195
Provider Business Practice Location Address
First Line : 537 W 8TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-3119
Country : US
Telephone Number : 310-891-0096
Fax Number : 310-891-0195
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MRS. LANETA JOYCE HILL
Credential :
Telephone Number : 310-891-0096
Provider Enumeration Date : 01/30/2017
Last Update Date : 02/14/2019

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