Provider Demographics
NPI:1336970730
Name:BRIGHT HORIZONS LIVING LLC
Entity type:Organization
Organization Name:BRIGHT HORIZONS LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FONTASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-497-6998
Mailing Address - Street 1:699 WALNUT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3949
Mailing Address - Country:US
Mailing Address - Phone:515-497-6998
Mailing Address - Fax:515-992-2270
Practice Address - Street 1:699 WALNUT ST STE 4
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3949
Practice Address - Country:US
Practice Address - Phone:515-497-6998
Practice Address - Fax:515-992-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities