Provider Demographics
NPI:1760929731
Name:BRIGHTCARE
Entity Type:Organization
Organization Name:BRIGHTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NYOME
Authorized Official - Middle Name:BRIGHT
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-330-5836
Mailing Address - Street 1:8091 LACY DR APT 202
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7467
Mailing Address - Country:US
Mailing Address - Phone:703-330-5836
Mailing Address - Fax:703-563-9663
Practice Address - Street 1:7845 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2883
Practice Address - Country:US
Practice Address - Phone:703-330-5836
Practice Address - Fax:703-563-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1103739261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0230260787Medicaid