MEDICARE: BRIGHT PATH SUPPORT 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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1952244022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT PATH SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	333 W BROWN DEER RD
Second Line	:
City	:	BAYSIDE
State	:	WI
Zip	:	53217-2372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3363 S 23RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4809
Country	:	US
Telephone Number	:	262-993-3295
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTAJAH COLE
Credential	:
Telephone Number	:	262-993-3295

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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