Provider Demographics
NPI:1962058024
Name:BRIGHT LANTERN HOME CARE
Entity type:Organization
Organization Name:BRIGHT LANTERN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TUYISHIMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-989-2921
Mailing Address - Street 1:14 POWSLAND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2622
Mailing Address - Country:US
Mailing Address - Phone:808-989-2921
Mailing Address - Fax:
Practice Address - Street 1:14 POWSLAND ST APT 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2622
Practice Address - Country:US
Practice Address - Phone:808-989-2921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility