Provider Demographics
NPI:1063662773
Name:FUNCTIONAL THERAPEUTICS INC DBA BRIGHTSTAR HEALTHCARE
Entity Type:Organization
Organization Name:FUNCTIONAL THERAPEUTICS INC DBA BRIGHTSTAR HEALTHCARE
Other - Org Name:BRIGHTSTAR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OREST
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNEVALE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:414-332-3884
Mailing Address - Street 1:5261 N PORT WASHINGTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4903
Mailing Address - Country:US
Mailing Address - Phone:414-332-3884
Mailing Address - Fax:414-332-3887
Practice Address - Street 1:5261 N PORT WASHINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4903
Practice Address - Country:US
Practice Address - Phone:414-332-3884
Practice Address - Fax:414-332-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health