Healthcare Provider Details

I. General information

NPI: 1255991105
Provider Name (Legal Business Name): BRILLIANT HEALTH HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 S CENTRAL AVE STE 205
GLENDALE CA
91204-4340
US

IV. Provider business mailing address

730 S CENTRAL AVE STE 205
GLENDALE CA
91204-4340
US

V. Phone/Fax

Practice location:
  • Phone: 747-240-6028
  • Fax: 747-240-6706
Mailing address:
  • Phone: 747-240-6028
  • Fax: 747-240-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LARRY TREYSTMAN
Title or Position: MANAGER
Credential:
Phone: 747-240-6028