Provider Demographics
NPI:1003230574
Name:BRILLIANT HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:BRILLIANT HEALTH SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALPHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-834-5692
Mailing Address - Street 1:4055 SPENCER ST STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5251
Mailing Address - Country:US
Mailing Address - Phone:702-834-5692
Mailing Address - Fax:702-834-5871
Practice Address - Street 1:4055 SPENCER ST STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5251
Practice Address - Country:US
Practice Address - Phone:702-834-5692
Practice Address - Fax:702-834-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NV7600HHA-0251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health