Provider Demographics
NPI:1265045371
Name:BRIGHTSIDE RECOVERY
Entity Type:Organization
Organization Name:BRIGHTSIDE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-220-1378
Mailing Address - Street 1:1667 BELVIDERE RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-9306
Mailing Address - Country:US
Mailing Address - Phone:708-360-7022
Mailing Address - Fax:
Practice Address - Street 1:1667 BELVIDERE RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-9306
Practice Address - Country:US
Practice Address - Phone:779-237-3550
Practice Address - Fax:224-205-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health