MEDICARE: BRIGHT PLACE 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1609499813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT PLACE LLC

Provider Business Mailing Address
First Line	:	3835 BAKKEN BLVD
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-5056
Country	:	US
Telephone Number	:	763-746-6653
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 BAKKEN BLVD
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-5056
Country	:	US
Telephone Number	:	763-746-6653
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSMAN AHMED
Credential	:
Telephone Number	:	763-746-6653

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/21/2020

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Directions to “BRIGHT PLACE LLC ” Practice Location

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