Provider Demographics
NPI:1518665843
Name:BRIGHTMINDSBYGRACE
Entity Type:Organization
Organization Name:BRIGHTMINDSBYGRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER INDEPENDENT PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:BUSTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:646-462-8727
Mailing Address - Street 1:4996 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1635
Mailing Address - Country:US
Mailing Address - Phone:646-462-8727
Mailing Address - Fax:
Practice Address - Street 1:4996 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1635
Practice Address - Country:US
Practice Address - Phone:646-462-8727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency