Provider Demographics
NPI:1235945023
Name:BRIGHT HORIZONS RESPITE
Entity type:Organization
Organization Name:BRIGHT HORIZONS RESPITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHENITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-519-8875
Mailing Address - Street 1:2235 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-7103
Mailing Address - Country:US
Mailing Address - Phone:815-519-8875
Mailing Address - Fax:
Practice Address - Street 1:2235 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-7103
Practice Address - Country:US
Practice Address - Phone:815-519-8875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities