Blackbird Senior Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BLACKBIRD SENIOR LIVING, INC.

Doing business as

The Citadel Assisted Living Facility

Practice address

520 S Higley Rd
Mesa, AZ 85206-2153

Phone

(480) 832-7600

Fax

(480) 832-3860

NPI assigned

Jan 25, 2022

Last updated

Mar 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Soon Burnam

Title

Treasurer

Phone

(949) 540-1249

Specialties & licenses 1

Addresses

Other names 1

• The Citadel Assisted Living Facility Doing business as

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1093467623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 S HIGLEY RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062153",
            "telephone_number": "480-832-7600",
            "fax_number": "480-832-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S HIGLEY RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062153",
            "telephone_number": "480-832-7600",
            "fax_number": "480-832-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKBIRD SENIOR LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Citadel Assisted Living Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erika Black, MSW, LMSW
• Jessica Black
• Kelly Black, PMHNP-BC
• Nicole Black, COTA
• Timothy E Black, MD
• Patrick Wayne Blackburn, MD
• Jared Blacker, DDS
• Davona D Blackhorse, LAC
• Carmen L Blackshear, HOME HEALTH AID
• Maria Elaine Blahut

• Assisted Living Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; 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.