Organization
BRIGHTHAVEN HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANTOSH P GAUR (MANAGING MEMBER)
(919) 844-6864
Entity
Organization
Contact information
Practice address
2705 BRIGHTHAVEN DR, RALEIGH, NC 27614-6745
(919) 846-2308
Mailing address
5516 PEAKTON DR, RALEIGH, NC 27614-9707
(919) 844-6864
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
07/10/2019
Last updated
11/26/2019
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