Provider Demographics
| NPI: | 1609695071 |
|---|---|
| Name: | BRIGHTWAY HEALTHCARE GROUP, INC. |
| Entity type: | Organization |
| Organization Name: | BRIGHTWAY HEALTHCARE GROUP, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LACY-ANN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MOMANYI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 321-363-1576 |
| Mailing Address - Street 1: | 532 TETON ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LAKE MARY |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 32746-2219 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 321-363-1576 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 532 TETON ST |
| Practice Address - Street 2: | |
| Practice Address - City: | LAKE MARY |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 32746-2219 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 321-363-1576 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-10-03 |
| Last Update Date: | 2024-10-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251J00000X | Agencies | Nursing Care | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
| No | 3416L0300X | Transportation Services | Ambulance | Land Transport |
| No | 385H00000X | Respite Care Facility | Respite Care | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
