Organization
BRIGHTSIDE DAY HABILITATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EARL JOHNSON JR. MPA (BOARD)
(225) 773-3999
Entity
Organization
Contact information
Practice address
557 E MAIN ST, BRUSLY, LA 70719-2210
(225) 615-7018
(225) 615-7492
Mailing address
557 E MAIN ST, BRUSLY, LA 70719-2210
(225) 615-7018
(225) 615-7492
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
2203781925
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2203781925
—
LA
Enumeration date
05/10/2018
Last updated
05/10/2018
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