Provider Demographics
NPI:1588322390
Name:BRIGHTSTAR HEALTH AND WELLNESS SERVICES
Entity type:Organization
Organization Name:BRIGHTSTAR HEALTH AND WELLNESS SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-443-9970
Mailing Address - Street 1:163 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535-1400
Mailing Address - Country:US
Mailing Address - Phone:508-637-1604
Mailing Address - Fax:
Practice Address - Street 1:163 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01535-1400
Practice Address - Country:US
Practice Address - Phone:508-637-1604
Practice Address - Fax:508-637-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care