Provider Demographics
NPI:1881102713
Name:BRIGHTSON MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:BRIGHTSON MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHILOMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWECHI
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:973-580-8159
Mailing Address - Street 1:68 WINDING HILL DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5671
Mailing Address - Country:US
Mailing Address - Phone:973-580-8159
Mailing Address - Fax:
Practice Address - Street 1:68 WINDING HILL DR
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-5671
Practice Address - Country:US
Practice Address - Phone:973-580-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00508400261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health