NPIMap

Organization Active NPI

State of Arizona State Dept of Finance

  • Skilled Nursing Facility
  • Phoenix, AZ
National Provider Identifier
1013009745
Registry record updated Mar 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCI-447 Issued in AZ
Legal business name
STATE OF ARIZONA STATE DEPT OF FINANCE
Practice address
4141 North S. Herrera Way
Phoenix, AZ 85012
Phone
(602) 512-2955
Fax
(602) 265-3497
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2017

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

Authorized official

Name
Mr. James Ross
Title
Administrator
Phone
(602) 248-1591

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X
Skilled Nursing Facility 314000000X NCI-447 AZ Primary

Addresses

Primary practice location

4141 North S. Herrera Way
Phoenix, AZ 85012

Mailing address

4141 North S. Herrera Way
Phoenix, AZ 85012
Phone (602) 512-2955

Other identifiers 1

IdentifierTypeStateIssuer
344432MedicaidAZ

Other names 1

  • Arizona State Veterans' Home Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120404000850 AZ Part A Provider - Skilled Nursing Facility 5991699647 Practice locations: Phoenix, AZ

Skilled nursing facility certification: CCN 035234

Legal name
ARIZONA DEPARTMENT OF VETERANS SERVICES
Doing business as
ARIZONA DEPARTMENT OF VETERAN SERVICES
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 8, 1996
Last certification
Jul 21, 2023
Beds
200
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
4141 N S Herrera Way
Phoenix, AZ 85012-1814
Nursing home name
ARIZONA STATE VETERAN HOME-PHX

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Arizona State Veteran Home-PhxCCN 035234
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Jan 8, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
20096.0 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
4Fines totaling $23,296

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Arizona Training Program - Pinchot32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Justina Garcia Individual W-2 Managing EmployeeBusiness Office Manager Jan 1, 2021 5%
Arizona Department of Veterans Services Organization, Phoenix, AZ Non-profit Other Nov 1, 1995 100%

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Arizona State HospitalPhoenix, AZ, CCN 034021 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1966
Arizona State Veteran Home - TucsonTucson, AZ, CCN 035284 Skilled nursing facility 5% Or Greater Direct Ownership Interest Jan 31, 2011
State of Arizona/State Dept of FinanceYuma, AZ, CCN 035303 Skilled nursing facility 5% Or Greater Direct Ownership Interest (5%) Oct 3, 2022

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489104000000",
    "number": "1013009745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 NORTH S. HERRERA WAY",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85012",
            "telephone_number": "602-512-2955",
            "fax_number": "602-265-3497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 NORTH S. HERRERA WAY",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85012",
            "telephone_number": "602-512-2955",
            "fax_number": "602-265-3497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ARIZONA STATE DEPT OF FINANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2017-03-10",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "602-248-1591",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344432",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona State Veterans' Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.