Provider Demographics
NPI:1043688864
Name:BRIGHTLIFE
Entity type:Organization
Organization Name:BRIGHTLIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEJIAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-500-5649
Mailing Address - Street 1:1990 LOUISVILLE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1202
Mailing Address - Country:US
Mailing Address - Phone:615-500-5649
Mailing Address - Fax:
Practice Address - Street 1:1990 LOUISVILLE RD STE 107
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1202
Practice Address - Country:US
Practice Address - Phone:615-500-5649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency