MEDICARE: BRILLIANT HEALTH SYSTEM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1003230574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANT HEALTH SYSTEM, INC.

Provider Business Mailing Address
First Line	:	4055 SPENCER ST STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5251
Country	:	US
Telephone Number	:	702-834-5692
Fax Number	:	702-834-5871

Provider Business Practice Location Address
First Line	:	4055 SPENCER ST STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5251
Country	:	US
Telephone Number	:	702-834-5692
Fax Number	:	702-834-5871

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALPHIE DE GUZMAN
Credential	:
Telephone Number	:	702-834-5692

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	06/12/2019

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