Basic Information
| Provider Information | |||||||||
| NPI: | 1083206122 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIGHT LIVING LEWISVILLE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 CROSS ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781305644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307304472 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750673871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723151532 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2021 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | WOMMACK | ||||||||
| AuthorizedOfficialFirstName: | TRAVIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO/MGR | ||||||||
| AuthorizedOfficialTelephone: | 8307304470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.