Organization
BRIGHTER HEIGHTS ARIZONA, LLC DBA SMOKI TRAIL
Active
Parent organization
BRIGHTER HEIGHTS ARIZONA, LLC
Other names
SequelCare of Arizona, LLC dba Smoki Trail
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRIGHTER HEIGHTS ARIZONA, LLC
Authorized official
MS. BROOKE WILSON (SENIOR CREDENTIALING SPECIALIST)
(928) 910-7644
Entity
Organization
Contact information
Practice address
9435 E SMOKI TRAIL, DEWEY, AZ 86327-6990
(928) 632-5806
Mailing address
2517 N GREAT WESTERN DR., SUITE P, PRESCOTT VALLEY, AZ 86314-2597
(928) 777-3280
(928) 227-8493
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-2163
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
717407
AHCCCS ID
AZ
05
—
717407
—
AZ
Enumeration date
10/28/2006
Last updated
07/06/2022
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