NPIMap

Organization Active NPI

Brilliant Health System, Inc.

  • Home Health Agency
  • Las Vegas, NV
National Provider Identifier
1003230574
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
BRILLIANT HEALTH SYSTEM, INC.
Practice address
4055 Spencer St Ste 220
Las Vegas, NV 89119-5251
Phone
(702) 834-5692
Fax
(702) 834-5871
NPI assigned
Feb 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alphie De Guzman
Title
President
Phone
(702) 834-5692

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

4055 Spencer St Ste 220
Las Vegas, NV 89119-5251

Mailing address

4055 Spencer St Ste 220
Las Vegas, NV 89119-5251
Phone (702) 834-5692

Other practice location 1

1641 E Flamingo Rd
Suite 9
Las Vegas, NV 89119-5257
Phone (702) 834-5692

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160509000650 NV Part A Provider - Home Health Agency 6002115342 Practice locations: Las Vegas, NV

Home health agency certification: CCN 297235

Legal name
BRILLIANT HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 1, 2017
Last certification
Aug 1, 2017
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Aug 15, 2012 in NV
Enrollment address
4055 Spencer St
Ste 220
Las Vegas, NV 89119-5251
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Brilliant Health System, IncCCN 297235
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Aug 1, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

4055 Spencer St
Ste 220
Las Vegas, NV 89119
Phone (702) 834-5692

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Alphie E de Guzman Individual 5% Or Greater Direct Ownership Interest Sep 16, 2016 100%
Corporate Director Sep 16, 2016 100%
W-2 Managing EmployeePresident/Ceo/Board Member Sep 16, 2016 100%
Mercy C Labrado Individual W-2 Managing EmployeeAdministrator and Director of PA Apr 18, 2019 100%
Katrina Bidwell Individual W-2 Managing EmployeeAdministrator DPCS Jun 16, 2021 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 11

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1003230574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 SPENCER ST STE 220",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891195251",
            "telephone_number": "702-834-5692",
            "fax_number": "702-834-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 SPENCER ST STE 220",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891195251",
            "telephone_number": "702-834-5692",
            "fax_number": "702-834-5871"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1641 E Flamingo Rd",
            "address_2": "Suite 9",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891195257",
            "country_code": "US",
            "telephone_number": "702-834-5692",
            "fax_number": "702-834-5871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRILLIANT HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-04",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "DE GUZMAN",
        "authorized_official_first_name": "ALPHIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-834-5692"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.