Provider Demographics
NPI:1245655745
Name:BRIGHTER BEGINNINGS DRUG AND ALCOHOL REHABILITATION FACILITY
Entity type:Organization
Organization Name:BRIGHTER BEGINNINGS DRUG AND ALCOHOL REHABILITATION FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DUSEAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-750-9522
Mailing Address - Street 1:1704 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3063
Mailing Address - Country:US
Mailing Address - Phone:323-750-9524
Mailing Address - Fax:323-750-9522
Practice Address - Street 1:1704 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3063
Practice Address - Country:US
Practice Address - Phone:323-750-9524
Practice Address - Fax:323-750-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197319Medicaid