NPIMap

Organization Active NPI

Dpac Holdings LLC

Doing business as Desert Palm Adult Care

  • Assisted Living Facility
  • Phoenix, AZ
National Provider Identifier
1083060594
Registry record updated Jan 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL9483H Issued in AZ
Legal business name
DPAC HOLDINGS LLC
Doing business as
Desert Palm Adult Care
Practice address
1214 E Palmaire Dr
Phoenix, AZ 85020-5429
Phone
(602) 943-4842
Fax
(877) 867-5390
NPI assigned
May 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2019

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

Authorized official

Name
Mr. Jean Gonzvar
Title
Managing Member
Phone
(480) 331-8495

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL9483H AZ Primary

Addresses

Primary practice location

1214 E Palmaire Dr
Phoenix, AZ 85020-5429

Mailing address

1214 E Palmaire Ave
Phoenix, AZ 85020-5429

Other identifiers 1

IdentifierTypeStateIssuer
476089MedicaidAZ

Other names 1

  • Desert Palm Adult Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dpac Holdings LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1463097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1083060594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1214 E PALMAIRE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850205429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1214 E PALMAIRE DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850205429",
            "telephone_number": "602-943-4842",
            "fax_number": "877-867-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DPAC HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-13",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "GONZVAR",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "480-331-8495",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL9483H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "476089",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Palm Adult Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Desert Palm Adult Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 31, 2019; 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.