Healthcare Provider Details

I. General information

NPI: 1447069141
Provider Name (Legal Business Name): BRILLIANT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 W DUNLAP AVE STE E
PHOENIX AZ
85051-5300
US

IV. Provider business mailing address

3612 W DUNLAP AVE STE E
PHOENIX AZ
85051-5300
US

V. Phone/Fax

Practice location:
  • Phone: 602-315-9529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SCOVIA BASALIZA
Title or Position: CEO
Credential:
Phone: 240-559-7617