Basic Information
| Provider Information | |||||||||
| NPI: | 1043983075 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRIGHTER DAYS SOBER LIVING COMMUNITY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BRIGHTER DAYS LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456191038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408610977 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 609 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456191038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404510680 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2021 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CREMEANS | ||||||||
| AuthorizedOfficialFirstName: | SHELIA | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7408610977 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CDCA | ||||||||
| NPICertificationDate: | 01/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 1043983075 | 05 | OH | MEDICAID |