NPIMap

Organization Active NPI

Vision Group Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1013117613
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
BH2597 Issued in AZ
Legal business name
VISION GROUP HOME
Practice address
714 W Saint Kateri Dr
Phoenix, AZ 85041-5961
Phone
(623) 308-5414
Fax
(602) 232-2196
NPI assigned
Jul 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

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

Authorized official

Name
Ms. Keturah Ann Mattox, MBA, M.ED, M.A.
Title
Executive Director/Ceo
Phone
(623) 308-5414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X BH2597 AZ Primary

Addresses

Primary practice location

714 W Saint Kateri Dr
Phoenix, AZ 85041-5961

Mailing address

714 W Saint Kateri Dr
Phoenix, AZ 85041-5961
Phone (623) 308-5414

National Provider Directory

National Provider Directory
Tax ID family
Vision Group Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1013117613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 W SAINT KATERI DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850415961",
            "telephone_number": "623-308-5414",
            "fax_number": "602-232-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 W SAINT KATERI DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850415961",
            "telephone_number": "623-308-5414",
            "fax_number": "602-232-2196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "MATTOX",
        "authorized_official_first_name": "KETURAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/CEO",
        "authorized_official_telephone_number": "623-308-5414",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA, M.ED, M.A."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH2597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.