Provider Demographics
NPI:1790594000
Name:BRIGHTSTAR CHILDREN'S THERAPY, LLP
Entity type:Organization
Organization Name:BRIGHTSTAR CHILDREN'S THERAPY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HASHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AIDEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-228-5906
Mailing Address - Street 1:10540 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3428
Mailing Address - Country:US
Mailing Address - Phone:952-228-5906
Mailing Address - Fax:218-416-9417
Practice Address - Street 1:10540 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-3428
Practice Address - Country:US
Practice Address - Phone:952-228-5906
Practice Address - Fax:218-416-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)