Provider Demographics
NPI:1225491178
Name:BRIGHTSIDE HOMECARE
Entity Type:Organization
Organization Name:BRIGHTSIDE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-903-1731
Mailing Address - Street 1:2020 W MCNAB RD STE 124
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1032
Mailing Address - Country:US
Mailing Address - Phone:954-903-1731
Mailing Address - Fax:
Practice Address - Street 1:2020 W MCNAB RD STE 124
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1032
Practice Address - Country:US
Practice Address - Phone:954-903-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211849OtherNURSE REGISTRY