Provider Demographics
NPI:1245359439
Name:BRITESMILZ FAMILY & COMMUNITY CONNECTIONS, LLC
Entity type:Organization
Organization Name:BRITESMILZ FAMILY & COMMUNITY CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-7575
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0086
Mailing Address - Country:US
Mailing Address - Phone:252-537-7575
Mailing Address - Fax:252-537-9008
Practice Address - Street 1:1165 GREGORY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6442
Practice Address - Country:US
Practice Address - Phone:252-537-7575
Practice Address - Fax:252-537-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408200Medicaid