Provider Demographics
NPI:1659713709
Name:BRIGHTSIDE DAY HABILITATION, INC
Entity Type:Organization
Organization Name:BRIGHTSIDE DAY HABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZABETH
Authorized Official - Middle Name:DELL
Authorized Official - Last Name:JOHNSON JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-650-5936
Mailing Address - Street 1:557 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BRUSLY
Mailing Address - State:LA
Mailing Address - Zip Code:70719-2210
Mailing Address - Country:US
Mailing Address - Phone:225-615-7492
Mailing Address - Fax:225-615-7018
Practice Address - Street 1:557 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BRUSLY
Practice Address - State:LA
Practice Address - Zip Code:70719-2210
Practice Address - Country:US
Practice Address - Phone:225-615-7492
Practice Address - Fax:225-615-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services