Provider Demographics
NPI:1629750237
Name:BRIGHTER NEW LIFE LLC
Entity Type:Organization
Organization Name:BRIGHTER NEW LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-4477
Mailing Address - Street 1:515 E BRADDOCK RD STE B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2161
Mailing Address - Country:US
Mailing Address - Phone:804-833-4477
Mailing Address - Fax:
Practice Address - Street 1:515 E BRADDOCK RD STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2161
Practice Address - Country:US
Practice Address - Phone:804-833-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder