NPIMap

Organization Active NPI

BWC Brighton LLC

Doing business as Blossom Children's Center-Brighton

  • Community/Behavioral Health Agency
  • Brighton, MI
National Provider Identifier
1104585421
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BWC BRIGHTON LLC
Doing business as
Blossom Children's Center-Brighton
Practice address
8175 Movie Dr
Brighton, MI 48116-7444
Phone
(248) 277-3005
Fax
(248) 277-3050
NPI assigned
Dec 14, 2021
Last updated
Nov 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ziad Koza
Title
Owner
Phone
(248) 860-6212

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X
Occupational Medicine Clinic/Center 261QX0100X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

8175 Movie Dr
Brighton, MI 48116-7444

Mailing address

8175 Movie Dr
Brighton, MI 48116-7444
Phone (248) 277-3005

Other names 1

  • Blossom Children's Center-Brighton Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211222001713 MI Part B Supplier - Clinic/Group Practice 0840681003 Receives reassigned benefits from 1 practitioner
Practice locations: Brighton, MI

National Provider Directory

National Provider Directory

Locations

8175 Movie Dr
Brighton, MI 48116
Phone (248) 277-3005

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1104585421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8175 MOVIE DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481167444",
            "telephone_number": "248-277-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8175 MOVIE DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481167444",
            "telephone_number": "248-277-3005",
            "fax_number": "248-277-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BWC BRIGHTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-14",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "KOZA",
        "authorized_official_first_name": "ZIAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-860-6212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blossom Children's Center-Brighton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brighton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.