Provider Demographics
NPI:1083437628
Name:BRIGHTFUTURE HAVEN LLC
Entity type:Organization
Organization Name:BRIGHTFUTURE HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES-FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-571-3072
Mailing Address - Street 1:6220 CHAVEL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7144
Mailing Address - Country:US
Mailing Address - Phone:252-571-3072
Mailing Address - Fax:
Practice Address - Street 1:10150 MALLARD CREEK RD STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4567
Practice Address - Country:US
Practice Address - Phone:704-727-3375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness