Provider Demographics
NPI:1841611464
Name:BRIGHT LIFE FARMS, INC
Entity Type:Organization
Organization Name:BRIGHT LIFE FARMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:KNOTH
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-388-6101
Mailing Address - Street 1:6773 US HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:KUTTAWA
Mailing Address - State:KY
Mailing Address - Zip Code:42055-5607
Mailing Address - Country:US
Mailing Address - Phone:270-388-6101
Mailing Address - Fax:270-388-6101
Practice Address - Street 1:10200 FARMERSVILLE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-5340
Practice Address - Country:US
Practice Address - Phone:270-365-0830
Practice Address - Fax:270-365-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY850070174400000X
KY850066174400000X
KY850082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty