Provider Demographics
NPI:1083597801
Name:ON THE BRIGHT SIDE RECOVERY LLC
Entity type:Organization
Organization Name:ON THE BRIGHT SIDE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEER SUPPORT WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:CPSW
Authorized Official - Phone:575-312-0676
Mailing Address - Street 1:809 S SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3634
Mailing Address - Country:US
Mailing Address - Phone:575-312-0676
Mailing Address - Fax:
Practice Address - Street 1:800 S TORNILLO ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3360
Practice Address - Country:US
Practice Address - Phone:575-312-0676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty