MEDICARE: BRIGHTER PROSPECTIVE RESIDENTIAL SERVICES, 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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1619424181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER PROSPECTIVE RESIDENTIAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	2509 TONOKA RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-1739
Country	:	US
Telephone Number	:	804-356-0947
Fax Number	:	804-562-2061

Provider Business Practice Location Address
First Line	:	2509 TONOKA ROAD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23223
Country	:	US
Telephone Number	:	804-386-9522
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GWENDOLYN L JORDAN
Credential	:
Telephone Number	:	804-562-2061

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	04/29/2019

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