MEDICARE: BRIGHTHAVEN HOMECARE, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1851182323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTHAVEN HOMECARE, LLC.

Provider Business Mailing Address
First Line	:	5100 NW 33RD AVE STE 245
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6381
Country	:	US
Telephone Number	:	561-962-5836
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 NW 33RD AVE STE 245
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6381
Country	:	US
Telephone Number	:	561-962-5836
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ERNSTLANDE DESTINE
Credential	:
Telephone Number	:	561-962-5836

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/14/2025

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