Provider Demographics
NPI: | 1356462543 |
---|---|
Name: | BRIGHTER HORIZONS BEHAVIORAL HEALTH |
Entity Type: | Organization |
Organization Name: | BRIGHTER HORIZONS BEHAVIORAL HEALTH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KIRKWOOD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 814-453-5806 |
Mailing Address - Street 1: | 23062 JERICHO RD |
Mailing Address - Street 2: | |
Mailing Address - City: | EDINBORO |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16412-5148 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-398-1805 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 23062 JERICHO RD |
Practice Address - Street 2: | |
Practice Address - City: | EDINBORO |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16412-5148 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-398-1805 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-03 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 0018006350001 | Medicaid |