Provider Demographics
NPI:1538346788
Name:BRIGHTWAY PERSONAL CARE HOME
Entity type:Organization
Organization Name:BRIGHTWAY PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:UGBALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-216-4073
Mailing Address - Street 1:6730 WINDING TRACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-1936
Mailing Address - Country:US
Mailing Address - Phone:281-405-0117
Mailing Address - Fax:281-397-7994
Practice Address - Street 1:6730 WINDING TRACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-1936
Practice Address - Country:US
Practice Address - Phone:281-405-0117
Practice Address - Fax:281-397-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility