Provider Demographics
NPI:1104585421
Name:BWC BRIGHTON LLC
Entity type:Organization
Organization Name:BWC BRIGHTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-860-6212
Mailing Address - Street 1:8175 MOVIE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-7444
Mailing Address - Country:US
Mailing Address - Phone:248-277-3005
Mailing Address - Fax:
Practice Address - Street 1:8175 MOVIE DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-7444
Practice Address - Country:US
Practice Address - Phone:248-277-3005
Practice Address - Fax:248-277-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty