Organization · NPI-2
Brilliant Start Wellness
Clinic/Center, Rehabilitation, Substance Use Disorder · Poway, CA
NPI number1043859077
StatusActive
Last updated in NPPESMay 12, 2020
Details
- NPI
- 1043859077
- Entity type
- Organization (NPI-2)
- Legal business name
- Brilliant Start Wellness
- Organization subpart
- No
- Enumeration date
- Dec 20, 2019
- Certification date
- May 12, 2020
- Last updated
- May 12, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – | Yes |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – |
Practice location
15644 Pomerado Rd Ste 200Poway, CA 92064-2455
Phone 619-408-7976
Mailing address
15644 Pomerado Rd Ste 200Poway, CA 92064-2455
Authorized official
Lilyan Hassaine
President
6194087976
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