Provider Demographics
NPI:1043529795
Name:BRIGHTWATER RETIREMENT, LLC
Entity Type:Organization
Organization Name:BRIGHTWATER RETIREMENT, LLC
Other - Org Name:LIVE LONG WELLCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-246-1616
Mailing Address - Street 1:101 BRIGHTWATER DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-8275
Mailing Address - Country:US
Mailing Address - Phone:843-903-8300
Mailing Address - Fax:843-236-1644
Practice Address - Street 1:101 BRIGHTWATER DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-8275
Practice Address - Country:US
Practice Address - Phone:843-903-8300
Practice Address - Fax:843-236-1644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR LIVING COMMUNITIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-0206251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health