Provider Demographics
NPI:1578858064
Name:BRIGHT HORIZON HOMES LLC
Entity Type:Organization
Organization Name:BRIGHT HORIZON HOMES LLC
Other - Org Name:BRIGHT HORIZON HOMES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MBA
Authorized Official - Phone:907-232-6624
Mailing Address - Street 1:1453 W KANABEC DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-9748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1453 W KANABEC DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9748
Practice Address - Country:US
Practice Address - Phone:907-232-6624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK948116251C00000X, 253J00000X, 385H00000X
AK100953310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253J00000XAgenciesFoster Care Agency
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC0042Medicaid