Provider Demographics
NPI:1083206122
Name:BRIGHT LIVING LEWISVILLE, LLC
Entity type:Organization
Organization Name:BRIGHT LIVING LEWISVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/MGR
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-730-4470
Mailing Address - Street 1:302 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5644
Mailing Address - Country:US
Mailing Address - Phone:830-730-4472
Mailing Address - Fax:
Practice Address - Street 1:400 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3871
Practice Address - Country:US
Practice Address - Phone:972-315-1532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility