Provider Demographics
NPI:1780777540
Name:BRIGHTER HEIGHTS ARIZONA, LLC DBA PRESCOTT HOUSE
Entity type:Organization
Organization Name:BRIGHTER HEIGHTS ARIZONA, LLC DBA PRESCOTT HOUSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:4001 NORTH CATHERINE DRIVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-775-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3650320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH3650OtherLIC#
AZBH4980OtherLIC #
AZ560284Medicaid
AZ560284OtherAHCCCS ID
AZBH-3650OtherLIC #