Provider Demographics
NPI:1053183046
Name:TRIBAL BRIGHT RESOURCE CENTER LLC
Entity type:Organization
Organization Name:TRIBAL BRIGHT RESOURCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-715-6178
Mailing Address - Street 1:7776 S POINTE PKWY W STE 260
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5407
Mailing Address - Country:US
Mailing Address - Phone:702-715-6718
Mailing Address - Fax:602-431-3181
Practice Address - Street 1:7776 S POINTE PKWY W STE 260
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5407
Practice Address - Country:US
Practice Address - Phone:702-715-6718
Practice Address - Fax:602-431-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)