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BRIGHTER HEIGHTS ARIZONA LLC DBA SMOKI TRAIL NPI 1588740930


NPI Information

NPI: 1588740930
Provider Name: BRIGHTER HEIGHTS ARIZONA, LLC DBA SMOKI TRAIL

Former Legal Business Name: SEQUELCARE OF ARIZONA, LLC DBA SMOKI TRAIL

Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address:
9435 E SMOKI TRAIL
DEWEY, AZ
ZIP 86327
Phone: (928) 632-5806
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BRIGHTER HEIGHTS ARIZONA, LLC DBA SMOKI TRAIL is a residential treatment facility emotionally disturbed children in Dewey, AZ. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. BRIGHTER HEIGHTS ARIZONA, LLC DBA SMOKI TRAIL NPI is 1588740930. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Sequelcare Of Arizona, Llc Dba Smoki Trail.

The provider's business location address is:

9435 E SMOKI TRAIL
DEWEY, AZ
ZIP 86327-990
Phone: (928) 632-5806

The provider's authorized official is Brooke Wilson .
The authorized official title is Senior Credentialing Specialist and has the following contact phone number (928) 910-7644.

The enumeration date for this NPI number is 10/28/2006 and was last updated on 7/6/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1322D00000XResidential Treatment Facility, Emotionally Disturbed ChildrenBH-2163ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1717407OTHERARIZONAAHCCCS ID
2717407MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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