Angie's LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

ANGIE'S LLC

Doing business as

Goodyear home

Practice address

16796 W Pierce St
Goodyear, AZ 85338-6167

Phone

(623) 215-2767

Fax

(623) 215-2927

NPI assigned

Dec 9, 2020

Organization subpart

No

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

Authorized official

Name

Miss Mireille Mukiza, MBA

Title

Cao

Phone

(623) 792-0191

Specialties & licenses 1

Addresses

Other names 1

• Goodyear home Doing business as

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1043816572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16796 W PIERCE ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853386167",
            "telephone_number": "623-792-0191",
            "fax_number": "623-215-2927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16796 W PIERCE ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853386167",
            "telephone_number": "623-215-2767",
            "fax_number": "623-215-2927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGIE'S LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "MUKIZA",
        "authorized_official_first_name": "MIREILLE",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "623-792-0191",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodyear home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in Goodyear, AZ
• Providers in Goodyear, 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 Dec 9, 2020; 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.