Provider Demographics
NPI:1609224807
Name:BRIGHTWORK ABA THERAPY
Entity Type:Organization
Organization Name:BRIGHTWORK ABA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:310-526-1099
Mailing Address - Street 1:4311 W 169TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3323
Mailing Address - Country:US
Mailing Address - Phone:310-526-1099
Mailing Address - Fax:
Practice Address - Street 1:4311 W 169TH ST
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3323
Practice Address - Country:US
Practice Address - Phone:310-526-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency