Provider Demographics
NPI:1528764693
Name:BRIGHT PATH GROUP LLC
Entity type:Organization
Organization Name:BRIGHT PATH GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GETACHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:YIRGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-503-2183
Mailing Address - Street 1:4315 W HOPI TRL
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2064
Mailing Address - Country:US
Mailing Address - Phone:602-503-2183
Mailing Address - Fax:
Practice Address - Street 1:7342 W ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7020
Practice Address - Country:US
Practice Address - Phone:602-503-2183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHT PATH GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-01
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Multi-Specialty