NPIMap

Organization Active NPI

Maricopa County Special Health Care District

Doing business as Maricopa Special Health Care District

  • Adult Mental Health Clinic/Center
  • Mesa, AZ
National Provider Identifier
1003273855
Registry record updated Jul 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
H3673 Issued in AZ
Legal business name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Doing business as
Maricopa Special Health Care District
Practice address
570 W Brown Rd
Mesa, AZ 85201-3227
Phone
(602) 344-8178
Fax
(602) 344-8122
NPI assigned
Jan 25, 2016
Last updated
Jul 17, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2017

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

Authorized official

Name
Kathleen Kirkland
Title
PFS Director
Phone
(602) 344-8178

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X H3673 AZ Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X H3673 AZ

Addresses

Primary practice location

570 W Brown Rd
Mesa, AZ 85201-3227

Mailing address

PO Box 29670
Phoenix, AZ 85038-9670
Phone (602) 344-8178

Other identifiers 7

IdentifierTypeStateIssuer
50005OtherAZEVERCARE CHOICE
020107MedicaidAZ
189350800OtherAZUS DEPT OF LABOR
29517OtherAZPHOENIX INDIAN MED CENTER
631935OtherAZAETNA
AZ0205850OtherAZBLUE CROSS BLUE SHIELD
AZ0947OtherAZHEALTHNET OF AZ

Other names 1

  • Maricopa Special Health Care District Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000823 AZ Part B Supplier - Clinic/Group Practice 4688583651 Receives reassigned benefits from 301 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chandler, AZ; Phoenix, AZ; Peoria, AZ; Mesa, AZ; Guadalupe, AZ; Avondale, AZ
O20070811000121 AZ Part A Provider - Hospital 4688583651 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Avondale, AZ; Mesa, AZ; Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003273855. Details of each certification follow.

Hospital certification: CCN 03S022

Legal name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Doing business as
VALLEYWISE HEALTH
Organization structure
GovernmentNon-profit
Enrollment address
2619 E Pierce St
Phoenix, AZ 85008-6092
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

5650 S 35th Ave
Phoenix, AZ 85041
Phone (602) 344-1376

934 W Hatcher Rd
Phoenix, AZ 85021
Phone (602) 344-6300

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Maricopa County Special Health Care District Organization, Phoenix, AZ Operational/Managerial Control Jan 1, 2005
Claire Frieda Agnew Individual Corporate Director Aug 3, 2020
James W. Thomas Individual Corporate Director Oct 24, 2018
Susan Gerard Individual Corporate Director Nov 1, 2010
Eugene Cavallo Individual Corporate Director May 10, 2007
W-2 Managing Employee May 10, 2007
Mary Rose Wilcox Individual Corporate Director Dec 5, 2016
Pamela Fowler Individual W-2 Managing Employee Jul 23, 2018
Operational/Managerial ControlDirector Jul 23, 2018
Mark Dewane Individual Corporate Director Nov 1, 2012
Stephen Purves Individual W-2 Managing Employee Sep 30, 2013
Mary Harden Individual Corporate Director Nov 1, 2012

Owners & managing parties with NPI records 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500249600000",
    "number": "1003273855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29670",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850389670",
            "telephone_number": "602-344-8178",
            "fax_number": "602-344-8122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 W BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013227",
            "telephone_number": "602-344-8178",
            "fax_number": "602-344-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-25",
        "last_updated": "2017-07-17",
        "status": "A",
        "authorized_official_last_name": "KIRKLAND",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "PFS DIRECTOR",
        "authorized_official_telephone_number": "602-344-8178"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "AZ",
            "license": "H3673",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "AZ",
            "license": "H3673",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE  CHOICE",
            "identifier": "50005",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020107",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "189350800",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHOENIX INDIAN MED CENTER",
            "identifier": "29517",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "631935",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0205850",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET OF AZ",
            "identifier": "AZ0947",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maricopa Special Health Care District",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.