Healthcare Provider Details

I. General information

NPI: 1154443331
Provider Name (Legal Business Name): BRIGHTER HEIGHTS ARIZONA, LLC -FOSTER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/21/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8603 E. EASTRIDGE DRIVE STE. A
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

2517 N GREAT WESTERN DR. SUITE P
PRESCOTT VALLEY AZ
86314-2597
US

V. Phone/Fax

Practice location:
  • Phone: 928-777-3280
  • Fax: 928-778-1252
Mailing address:
  • Phone: 928-777-3280
  • Fax: 928-227-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberA7
License Number StateAZ

VIII. Authorized Official

Name: MS. BROOKE WILSON
Title or Position: SENIOR CREDENTIALING SPECIALIST
Credential:
Phone: 928-910-7644