MEDICARE: A BRIGHTER YOU 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861620080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BRIGHTER YOU LLC

Provider Business Mailing Address
First Line	:	3409 W WENDOVER AVE STE F
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1579
Country	:	US
Telephone Number	:	336-287-5933
Fax Number	:	336-722-4499

Provider Business Practice Location Address
First Line	:	3409 W WENDOVER AVE STE F
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1579
Country	:	US
Telephone Number	:	336-287-5933
Fax Number	:	336-722-4499

Authorized Official
Title or Position	:	OWNER/EXECUTIVE DIRECTOR
Name	:	MS. TRINETTE MITCHELL
Credential	:
Telephone Number	:	336-287-5933

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	07/22/2009

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