Healthcare Provider Details

I. General information

NPI: 1932033537
Provider Name (Legal Business Name): BRIGHT PATH LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13379 W TARA LN
SURPRISE AZ
85374-5281
US

IV. Provider business mailing address

13379 W TARA LN
SURPRISE AZ
85374-5281
US

V. Phone/Fax

Practice location:
  • Phone: 602-802-2880
  • Fax:
Mailing address:
  • Phone: 602-802-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MICAH SHAWN CORDELL PETE
Title or Position: CEO/FOUNDER
Credential:
Phone: 602-802-2880