Provider Demographics
NPI:1073387874
Name:FBTC TRANSITIONAL SUB, LLC
Entity Type:Organization
Organization Name:FBTC TRANSITIONAL SUB, LLC
Other - Org Name:BRIGHT LIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & SR. ASST GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RODENBERG-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-836-2234
Mailing Address - Street 1:55 TOZER RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5515
Mailing Address - Country:US
Mailing Address - Phone:978-969-2894
Mailing Address - Fax:978-969-2637
Practice Address - Street 1:1216 MANN DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5512
Practice Address - Country:US
Practice Address - Phone:980-262-3043
Practice Address - Fax:980-339-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health