| Organization Name: | ABRIGHTERLIGHTRESDIENTIAL CARE HOME LLC |
| NPI Number: | 1073994596 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATTI LYNN BIRGE (OWNER/ADMINISTOR) |
| Mailing Address: | 2708 S Hemlock Ave Broken Arrow |
| State: | OK US |
| Postal Code: | 740120817 |
| Phone Number: | 9183785686 |
| Fax Number: | 9182861404 |
| NPI Enumeration Date: | 06/10/2015 |
| NPI Last Update Date: | 06/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | RC7276 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |