NPIMap

Organization Active NPI

FBTC Transitional Sub, LLC

  • Behavior Analyst
  • Rincon, GA
National Provider Identifier
1346969755
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
FBTC TRANSITIONAL SUB, LLC
Practice address
613 Towne Park Dr W
Rincon, GA 31326-5182
Phone
(508) 521-2200
Fax
(508) 427-2227
NPI assigned
Aug 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Mary Patricia Rodenberg-Roberts
Title
VP& Sr. Assistant General Counsel
Phone
(952) 836-2234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

613 Towne Park Dr W
Rincon, GA 31326-5182

Mailing address

55 Tozer Rd
Beverly, MA 01915-5515
Phone (978) 969-2894

Other practice location 1

806 Towne Park Dr
Rincon, GA 31326-9368
Phone (912) 677-4292

Other names 1

  • Bright Light Doing business as

National Provider Directory

National Provider Directory
Tax ID family
FBTC Transitional Sub LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3319 Argent Blvd
Ste A
Ridgeland, SC 29936

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1346969755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 TOZER RD",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019155515",
            "telephone_number": "978-969-2894",
            "fax_number": "978-969-2637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 TOWNE PARK DR W",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313265182",
            "telephone_number": "508-521-2200",
            "fax_number": "508-427-2227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "806 Towne Park Dr",
            "address_purpose": "LOCATION",
            "city": "Rincon",
            "state": "GA",
            "postal_code": "313269368",
            "country_code": "US",
            "telephone_number": "912-677-4292",
            "fax_number": "912-677-4292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FBTC TRANSITIONAL SUB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-26",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "RODENBERG-ROBERTS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "VP& SR. ASSISTANT GENERAL COUNSEL",
        "authorized_official_telephone_number": "952-836-2234"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bright Light",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rincon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.