MEDICARE: BRILLIANT CARE LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1447069141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANT CARE LLC

Provider Business Mailing Address
First Line	:	3612 W DUNLAP AVE STE E
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 W DUNLAP AVE STE E
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5300
Country	:	US
Telephone Number	:	602-315-9529
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SCOVIA BASALIZA
Credential	:
Telephone Number	:	240-559-7617

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	12/12/2025

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Directions to “BRILLIANT CARE LLC ” Practice Location

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