Provider Demographics
NPI:1013608496
Name:BRIGHT LIFE CARE RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:BRIGHT LIFE CARE RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIGHT
Authorized Official - Middle Name:NGABIRE
Authorized Official - Last Name:NTIMPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-904-0088
Mailing Address - Street 1:2220 W MISSION LN APT 2092
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2896
Mailing Address - Country:US
Mailing Address - Phone:602-904-0088
Mailing Address - Fax:
Practice Address - Street 1:5060 N 19TH AVE STE 317
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3213
Practice Address - Country:US
Practice Address - Phone:602-904-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care