Provider Demographics
NPI:1962565077
Name:BRIGHTWORK
Entity type:Organization
Organization Name:BRIGHTWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:801-694-3205
Mailing Address - Street 1:1603 E STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3669
Mailing Address - Country:US
Mailing Address - Phone:801-694-3205
Mailing Address - Fax:801-484-5968
Practice Address - Street 1:1603 E STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3669
Practice Address - Country:US
Practice Address - Phone:801-694-3205
Practice Address - Fax:801-484-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11289261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care