Provider Demographics
NPI:1639205586
Name:A BRIGHTER TOMORROW GROUP HOME
Entity Type:Organization
Organization Name:A BRIGHTER TOMORROW GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-681-3072
Mailing Address - Street 1:2214 ATLANTA ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-4002
Mailing Address - Country:US
Mailing Address - Phone:336-272-9503
Mailing Address - Fax:336-378-9478
Practice Address - Street 1:2214 ATLANTA ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4002
Practice Address - Country:US
Practice Address - Phone:336-272-9503
Practice Address - Fax:336-378-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-707322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603853Medicaid