NPIMap

Organization Active NPI

Mary'S Mission & Developmental Center, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Sierra Vista, AZ
National Provider Identifier
1083725832
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
BH-1422 Issued in AZ
Legal business name
MARY'S MISSION & DEVELOPMENTAL CENTER, INC
Practice address
345 Taylor Dr
Sierra Vista, AZ 85635-3801
Phone
(520) 417-2115
Fax
(520) 417-2114
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. William Lacey Jr., MBA
Title
Ceo/Administrator
Phone
(520) 417-2115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X BH-1422 AZ Primary

Addresses

Primary practice location

345 Taylor Dr
Sierra Vista, AZ 85635-3801

Mailing address

345 Taylor Dr
Sierra Vista, AZ 85635-3801
Phone (520) 417-2115

National Provider Directory

National Provider Directory
Tax ID family
Mary'S Mission Developmental Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083725832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 TAYLOR DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856353801",
            "telephone_number": "520-417-2115",
            "fax_number": "520-417-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 TAYLOR DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856353801",
            "telephone_number": "520-417-2115",
            "fax_number": "520-417-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY'S MISSION & DEVELOPMENTAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LACEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "520-417-2115",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH-1422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.