Provider Demographics
NPI:1467673335
Name:BRIGHTSIDE INC
Entity Type:Organization
Organization Name:BRIGHTSIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-748-9308
Mailing Address - Street 1:PO BOX 414484
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4484
Mailing Address - Country:US
Mailing Address - Phone:413-539-2973
Mailing Address - Fax:413-539-2454
Practice Address - Street 1:2112 RIVERDALE ST
Practice Address - Street 2:
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1024
Practice Address - Country:US
Practice Address - Phone:413-539-2973
Practice Address - Fax:413-539-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1474833322D00000X
MA5877322D00000X
MA1475734322D00000X
MA1475733322D00000X
MA1475735322D00000X
MA1475736322D00000X
MA1475732322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305263Medicaid
MAY10242Medicare ID - Type UnspecifiedMEDICARE NAT. HERITAGE OP
MA1305263Medicaid