Organization
BRIGHTHAVEN SUPPORTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE ISHIMWE (OWNER)
(208) 570-9092
Entity
Organization
Contact information
Practice address
1351 E MONA LISA DR, MERIDIAN, ID 83642-7885
(208) 570-9092
Mailing address
252 E FRONT ST, BOISE, ID 83702-7348
(208) 570-9092
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
11/06/2025
Last updated
11/18/2025
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