Provider Demographics
NPI:1043920549
Name:BRIGHTLIGHT HEALTHCARE LLC
Entity Type:Organization
Organization Name:BRIGHTLIGHT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-259-8528
Mailing Address - Street 1:4 TUCKAHOE CT APT 304
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 TUCKAHOE CT APT 304
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4378
Practice Address - Country:US
Practice Address - Phone:240-259-8528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health