Provider Demographics
NPI:1154701035
Name:BRIGHTON DIVERSION SERVICES INC.
Entity type:Organization
Organization Name:BRIGHTON DIVERSION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOLDITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-608-7399
Mailing Address - Street 1:97 MAPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CATHLAMET
Mailing Address - State:WA
Mailing Address - Zip Code:98612-9648
Mailing Address - Country:US
Mailing Address - Phone:360-608-7399
Mailing Address - Fax:
Practice Address - Street 1:97 MAPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:CATHLAMET
Practice Address - State:WA
Practice Address - Zip Code:98612-9648
Practice Address - Country:US
Practice Address - Phone:360-608-7399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care