Provider Demographics
NPI:1356553564
Name:BRIGHTLIFE INTERNATIONAL, INC
Entity type:Organization
Organization Name:BRIGHTLIFE INTERNATIONAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:ENABULELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-973-7322
Mailing Address - Street 1:11633 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2322
Mailing Address - Country:US
Mailing Address - Phone:310-973-7322
Mailing Address - Fax:310-973-4511
Practice Address - Street 1:11633 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2322
Practice Address - Country:US
Practice Address - Phone:310-973-7322
Practice Address - Fax:310-973-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5938250001Medicare NSC