Provider Demographics
NPI:1770676439
Name:BRIGHTER HEIGHTS ARIZONA, LLC DBA HUALAPAI MOUNTAIN
Entity Type:Organization
Organization Name:BRIGHTER HEIGHTS ARIZONA, LLC DBA HUALAPAI MOUNTAIN
Other - Org Name:SEQUELCARE OF ARIZONA LLC DBA HUALAPAI MOUNTAIN
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 1:3240 HUALAPAI MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401
Practice Address - Country:US
Practice Address - Phone:928-753-2665
Practice Address - Fax:928-753-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3903320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ954603Medicaid
AZ954603OtherAHCCCS ID