Provider Demographics
NPI:1073407698
Name:BRIGHT LIFE ABA
Entity type:Organization
Organization Name:BRIGHT LIFE ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAYIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-267-0360
Mailing Address - Street 1:1718 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2136
Mailing Address - Country:US
Mailing Address - Phone:845-304-5451
Mailing Address - Fax:
Practice Address - Street 1:110 E WAYNE ST FL 12
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2611
Practice Address - Country:US
Practice Address - Phone:845-304-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health