Provider Demographics
NPI:1699451393
Name:BRIGHTLIFE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:BRIGHTLIFE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP
Authorized Official - Prefix:
Authorized Official - First Name:TARSICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHERU
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:614-681-0012
Mailing Address - Street 1:700 BRYDEN RD # 122
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4839
Mailing Address - Country:US
Mailing Address - Phone:614-681-0012
Mailing Address - Fax:
Practice Address - Street 1:700 BRYDEN RD # 122
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4839
Practice Address - Country:US
Practice Address - Phone:614-681-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTLIFE BEHAVIORAL HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder