MEDICARE: BRIGHT PATH RESIDENTIAL CARE 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
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1346103223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT PATH RESIDENTIAL CARE LLC

Provider Business Mailing Address
First Line	:	481 WESTBROOK ST APT 303G
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-1922
Country	:	US
Telephone Number	:	207-838-3363
Fax Number	:

Provider Business Practice Location Address
First Line	:	481 WESTBROOK ST APT 303G
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-1922
Country	:	US
Telephone Number	:	207-838-3363
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MIGNONE MUBERARUGO
Credential	:
Telephone Number	:	207-838-3363

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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