Provider Demographics
NPI:1043104672
Name:BRILLIANT MIND WELLNESS
Entity type:Organization
Organization Name:BRILLIANT MIND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ULYSSES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-565-3555
Mailing Address - Street 1:13384 W RIMROCK ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5211
Mailing Address - Country:US
Mailing Address - Phone:623-565-3555
Mailing Address - Fax:
Practice Address - Street 1:149 E JOAN D ARC AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4704
Practice Address - Country:US
Practice Address - Phone:623-565-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances