Provider Demographics
NPI:1669206124
Name:BRIGHTER DAYS PPEC OF PALM BAY
Entity type:Organization
Organization Name:BRIGHTER DAYS PPEC OF PALM BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-610-8718
Mailing Address - Street 1:1464 TROUTMAN BLVD NE STE 106
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4101
Mailing Address - Country:US
Mailing Address - Phone:321-610-8718
Mailing Address - Fax:321-655-5154
Practice Address - Street 1:1464 TROUTMAN BLVD NE STE 106
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4101
Practice Address - Country:US
Practice Address - Phone:321-655-5154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric