Organization
BRIGHTER HEIGHTS ARIZONA, LLC DBA HUALAPAI MOUNTAIN
Active
Other names
SequelCare of Arizona LLC dba Hualapai Mountain
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BROOKE WILSON (SENIOR CREDENTIALING SPECIALIST)
(928) 910-7644
Entity
Organization
Contact information
Practice address
3240 HUALAPAI MOUNTAIN ROAD, KINGMAN, AZ 86401
(928) 753-2665
(928) 753-1556
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
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-3903
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
954603
AHCCCS ID
AZ
05
—
954603
—
AZ
Enumeration date
10/02/2006
Last updated
07/05/2022
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