MEDICARE: BRIGHTNEST 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1881587749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTNEST LLC

Provider Business Mailing Address
First Line	:	220 ROBERT ST S STE 204
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-1692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 ROBERT ST S STE 204
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-1692
Country	:	US
Telephone Number	:	651-468-1365
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	DAGIM TESHOME DEMEKE
Credential	:
Telephone Number	:	651-468-1365

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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Directions to “BRIGHTNEST LLC ” Practice Location

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