Provider Demographics
NPI:1760728885
Name:BRIGHT EYES ASSISTED LIVING
Entity Type:Organization
Organization Name:BRIGHT EYES ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANDRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-710-0156
Mailing Address - Street 1:920 GROSS RD APT 1024
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-8107
Mailing Address - Country:US
Mailing Address - Phone:214-710-0156
Mailing Address - Fax:
Practice Address - Street 1:6327 TEAGUE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-4844
Practice Address - Country:US
Practice Address - Phone:214-372-3690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135796320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities