Provider Demographics
NPI:1508347162
Name:BRIGHT FUTURES WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:BRIGHT FUTURES WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-304-4961
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-0104
Mailing Address - Country:US
Mailing Address - Phone:203-304-4961
Mailing Address - Fax:203-306-2905
Practice Address - Street 1:422-426 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410
Practice Address - Country:US
Practice Address - Phone:203-304-4961
Practice Address - Fax:203-306-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2080P0006X, 363LP0200X, 363LP0808X
CT2442363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty