Provider Demographics
NPI:1093146789
Name:BRIGHTWAY ADULT DAYCARE CENTER LLC
Entity Type:Organization
Organization Name:BRIGHTWAY ADULT DAYCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHINENYE
Authorized Official - Middle Name:
Authorized Official - Last Name:UGBALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-602-5114
Mailing Address - Street 1:12808 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2004
Mailing Address - Country:US
Mailing Address - Phone:832-602-5114
Mailing Address - Fax:281-661-8186
Practice Address - Street 1:12808 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2004
Practice Address - Country:US
Practice Address - Phone:832-602-5114
Practice Address - Fax:281-661-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 163WA2000X, 163WP0808X, 164X00000X, 174200000X, 207Q00000X, 251B00000X, 261QC1500X, 310400000X, 343800000X, 343900000X
TX207Q00000X
TX100655261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No174200000XOther Service ProvidersMealsGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty