Provider Demographics
NPI:1750196911
Name:BRIGHTHAVEN HOME HEALTH
Entity type:Organization
Organization Name:BRIGHTHAVEN HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENGISTAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-930-3089
Mailing Address - Street 1:61 HAROLD L DOW HWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-2082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61 HAROLD L DOW HWY UNIT B
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-2082
Practice Address - Country:US
Practice Address - Phone:978-930-3089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health