Provider Demographics
NPI:1154443331
Name:BRIGHTER HEIGHTS ARIZONA, LLC -FOSTER CARE
Entity Type:Organization
Organization Name:BRIGHTER HEIGHTS ARIZONA, LLC -FOSTER CARE
Other - Org Name:SEQUELCARE OF ARIZONA, LLC-FOSTER CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SENIOR CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-910-7644
Mailing Address - Street 1:2517 N GREAT WESTERN DR.
Mailing Address - Street 2:SUITE P
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2597
Mailing Address - Country:US
Mailing Address - Phone:928-777-3280
Mailing Address - Fax:928-227-8493
Practice Address - Street 1:8603 E. EASTRIDGE DRIVE
Practice Address - Street 2:STE. A
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-777-3280
Practice Address - Fax:928-778-1252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTER HEIGHTS ARIZONA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZA7251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ========= A7OtherDEPT ECON SECY LICENSE #