MEDICARE: BRIGHTER HAVEN 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1467209338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER HAVEN INC.

Provider Business Mailing Address
First Line	:	560 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3534
Country	:	US
Telephone Number	:	313-605-0641
Fax Number	:	313-605-0641

Provider Business Practice Location Address
First Line	:	560 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3534
Country	:	US
Telephone Number	:	313-605-0641
Fax Number	:	313-571-9046

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. FELICIA JORDAN
Credential	:	BA
Telephone Number	:	313-605-0641

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	04/30/2024

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Directions to “BRIGHTER HAVEN INC. ” Practice Location

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