Provider Demographics
NPI:1992326029
Name:BRIGHTER HEIGHTS ARIZONA, LLC DBA OCOTILLO RANCH
Entity type:Organization
Organization Name:BRIGHTER HEIGHTS ARIZONA, LLC DBA OCOTILLO RANCH
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:
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 1:3001 N. MOUNTAIN VIEW RD
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:928-777-3280
Practice Address - Fax:928-717-1660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTER HEIGHTS ARIZONA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-29
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty