Healthcare Provider Details

I. General information

NPI: 1992326029
Provider Name (Legal Business Name): BRIGHTER HEIGHTS ARIZONA, LLC DBA OCOTILLO RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N. MOUNTAIN VIEW RD
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 928-777-3280
  • Fax: 928-717-1660
Mailing address:
  • Phone: 928-777-3280
  • Fax: 928-227-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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