Provider Demographics
NPI:1699458216
Name:BRIGHTER BRAINWAVE, LLC
Entity type:Organization
Organization Name:BRIGHTER BRAINWAVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RBT
Authorized Official - Prefix:
Authorized Official - First Name:ISIAH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-553-0082
Mailing Address - Street 1:1121 AUSTIN BLUFFS PKWY UNIT 424
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3955
Mailing Address - Country:US
Mailing Address - Phone:989-553-0082
Mailing Address - Fax:
Practice Address - Street 1:1121 AUSTIN BLUFFS PKWY # 424
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3955
Practice Address - Country:US
Practice Address - Phone:989-553-0082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child