NPIMap

Organization Active NPI

Mary Group Home LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1033645668
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH5112 Issued in AZ
Legal business name
MARY GROUP HOME LLC
Practice address
15111 N 33Rd PL
Phoenix, AZ 85032-4552
Phone
(623) 565-3922
NPI assigned
May 2, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Authorized official

Name
Abdalla Elkhalifa
Title
Ceo/Owner
Phone
(623) 565-3922

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH5112 AZ Primary

Addresses

Primary practice location

15111 N 33Rd PL
Phoenix, AZ 85032-4552

Mailing address

2084 E Washington Ave
Gilbert, AZ 85234-6229
Phone (623) 565-3922

National Provider Directory

National Provider Directory
Tax ID family
Mary Group Home LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1493683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748908800000",
    "number": "1033645668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2084 E WASHINGTON AVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852346229",
            "telephone_number": "623-565-3922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15111 N 33RD PL",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850324552",
            "telephone_number": "623-565-3922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-02",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A",
        "authorized_official_last_name": "ELKHALIFA",
        "authorized_official_first_name": "ABDALLA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "623-565-3922"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH5112",
            "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 Jun 3, 2025; 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.