Eureka Annex Residence

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

EUREKA ANNEX RESIDENCE

Practice address

2668 S Heritage Dr
Gilbert, AZ 85295-7164

Phone

(480) 264-2647

NPI assigned

Feb 17, 2014

Organization subpart

Yes

Parent organization

EUREKA IMPERIAL RESIDENCEAs reported in NPPES

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

Authorized official

Name

Mr. Cornelius Tanyi

Title

Program Director

Phone

(480) 264-2647

Specialties & licenses 2

Addresses

Part of

Eureka Imperial Residence 3

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Eureka Imperial Residence

  • Mental Illness Community Based Residential Treatment Facility
  • Gilbert, AZ
  • NPI 1679704381
  NPPES parent name

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

{
    "created_epoch": "1392595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392595200000",
    "number": "1043634769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 S HERITAGE DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852954851",
            "telephone_number": "480-264-2647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2668 S HERITAGE DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852957164",
            "telephone_number": "480-264-2647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUREKA ANNEX RESIDENCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EUREKA IMPERIAL RESIDENCE",
        "enumeration_date": "2014-02-17",
        "last_updated": "2014-02-17",
        "status": "A",
        "authorized_official_last_name": "TANYI",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "480-264-2647",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Estrella Ear, Nose and Throat PC
• Amir Michael Etebari, DDS
• Amir Etemad, MD
• Carla Jean Ethridge, R.N.
• Theodore Webster Etling Jr., PSYD
• Eureka Imperial Residence
• Eureka Imperial Residence
• Eureka Imperial Residence 3
• Ev Chiropractic, LLC
• Karen Evancic, CNM

• Mental Illness Community Based Residential Treatment Facility in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2014; 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.