Provider Demographics
NPI:1821568627
Name:BRIGHT KIDNEY CARE LLC
Entity Type:Organization
Organization Name:BRIGHT KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINICAL & REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-522-3905
Mailing Address - Street 1:2000 HARTMAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4412
Mailing Address - Country:US
Mailing Address - Phone:772-467-1117
Mailing Address - Fax:772-595-9340
Practice Address - Street 1:2000 HARTMAN RD STE 2
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4412
Practice Address - Country:US
Practice Address - Phone:772-467-1117
Practice Address - Fax:772-595-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment