Provider Demographics
NPI:1336868769
Name:FBTC TRANSITIONAL SUB, LLC
Entity Type:Organization
Organization Name:FBTC TRANSITIONAL SUB, LLC
Other - Org Name:BRIGHT LIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP& SR. ASST GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RODENBERG-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-836-2234
Mailing Address - Street 1:55 TOZER RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5515
Mailing Address - Country:US
Mailing Address - Phone:978-969-2894
Mailing Address - Fax:978-969-2637
Practice Address - Street 1:3229 ARGENT BLVD STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-3114
Practice Address - Country:US
Practice Address - Phone:508-521-2200
Practice Address - Fax:508-427-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty