Provider Demographics
NPI:1386883833
Name:BRIGHT HOUSE MEMORY CARE AGENCY
Entity type:Organization
Organization Name:BRIGHT HOUSE MEMORY CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-845-3318
Mailing Address - Street 1:926 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-1602
Mailing Address - Country:US
Mailing Address - Phone:434-845-1777
Mailing Address - Fax:434-845-1788
Practice Address - Street 1:926 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-1602
Practice Address - Country:US
Practice Address - Phone:434-845-1777
Practice Address - Fax:434-845-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO09548251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health