Provider Demographics
NPI:1912775255
Name:BRIGHT TRACK KIDS, LLC
Entity type:Organization
Organization Name:BRIGHT TRACK KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:224-202-7067
Mailing Address - Street 1:8081 W BROOKS DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9724
Mailing Address - Country:US
Mailing Address - Phone:224-202-7067
Mailing Address - Fax:224-526-5164
Practice Address - Street 1:8081 W BROOKS DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-9724
Practice Address - Country:US
Practice Address - Phone:224-202-7067
Practice Address - Fax:224-526-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1891050746OtherNATIONAL PROVIDER INDENTIFIER