Provider Demographics
NPI:1487203832
Name:BRIGHTLANE HEALTHCARE INC
Entity Type:Organization
Organization Name:BRIGHTLANE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATACSIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-529-8247
Mailing Address - Street 1:5050 PALO VERDE ST STE 212
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2334
Mailing Address - Country:US
Mailing Address - Phone:909-529-8247
Mailing Address - Fax:800-401-3294
Practice Address - Street 1:5050 PALO VERDE ST STE 212
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2334
Practice Address - Country:US
Practice Address - Phone:909-529-8247
Practice Address - Fax:800-401-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health