NPIMap

Organization Active NPI

Maricopa County Special Health Care District

Doing business as Valleywise Health

  • Adult Mental Health Clinic/Center
  • Avondale, AZ
National Provider Identifier
1043679327
Registry record updated Oct 22, 2019
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
Valleywise Health
Practice address
950 E Van Buren St
Avondale, AZ 85323-1506
Phone
(602) 344-2520
Fax
(602) 344-8122
NPI assigned
Feb 16, 2016
Last updated
Oct 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

950 E Van Buren St
Avondale, AZ 85323-1506

Mailing address

PO Box 29670
Phoenix, AZ 85008
Phone (602) 344-8178

Other identifiers 7

IdentifierTypeStateIssuer
29517OtherAZPHOENIX INDIAN MED CENTER
020107MedicaidAZ
AZ0205850OtherAZBLUE CROSS BLUE SHIELD
189350800OtherAZUS DEPT OF LABOR
50005OtherAZEVERCARE CHOICE
631935OtherAZAETNA
AZ0947OtherAZHEALTH NET OF AZ

Other names 1

  • Valleywise Health 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 1043679327. 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
Tax ID family
Maricopa County Special Health Care District23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

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 50

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 50

NPI Registry JSON

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

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571702400000",
    "number": "1043679327",
    "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": "85008",
            "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": "950 E VAN BUREN ST",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853231506",
            "telephone_number": "602-344-2520",
            "fax_number": "602-344-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-16",
        "last_updated": "2019-10-22",
        "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": "PHOENIX INDIAN MED CENTER",
            "identifier": "29517",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020107",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0205850",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "189350800",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE CHOICE",
            "identifier": "50005",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "631935",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET OF AZ",
            "identifier": "AZ0947",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valleywise Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avondale, AZ

Sources for this page

Verify at the official NPI Registry.