Organization
BRIGHTER BRAINWAVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISIAH ANDREW GRAY (OWNER/RBT)
(989) 553-0082
Entity
Organization
Contact information
Practice address
1121 AUSTIN BLUFFS PKWY # 424, COLORADO SPRINGS, CO 80918-3955
(989) 553-0082
Mailing address
1121 AUSTIN BLUFFS PKWY UNIT 424, COLORADO SPRINGS, CO 80918-3955
(989) 553-0082
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
08/10/2023
Last updated
08/11/2023
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