Provider Demographics
NPI:1215112339
Name:SUSAN A BRADY A BRIGHTER BEGINNING
Entity type:Organization
Organization Name:SUSAN A BRADY A BRIGHTER BEGINNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:ITFS
Authorized Official - Phone:252-223-2299
Mailing Address - Street 1:220 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9361
Mailing Address - Country:US
Mailing Address - Phone:252-223-2299
Mailing Address - Fax:
Practice Address - Street 1:220 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-9361
Practice Address - Country:US
Practice Address - Phone:252-223-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302179Medicaid