NPIMap

Organization Active NPI

Mary'S Mission and Developmental Center

  • Community/Behavioral Health Agency
  • Mesa, AZ
National Provider Identifier
1114221645
Registry record updated Dec 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
BH-3732 Issued in AZ
Legal business name
MARY'S MISSION AND DEVELOPMENTAL CENTER
Practice address
736 N Country Club Dr
Mesa, AZ 85201-4936
Phone
(480) 844-0011
NPI assigned
Dec 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2010

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

Authorized official

Name
Mr. William Lacey
Title
Ceo
Phone
(480) 844-0022

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X BH-3732 AZ Primary

Addresses

Primary practice location

736 N Country Club Dr
Mesa, AZ 85201-4936

Mailing address

736 N Country Club Dr
Mesa, AZ 85201-4936
Phone (480) 844-0011

Other names 1

  • Mary's Mission Outpatient Clinic Doing business as

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.

Locations

736 N Country Club Dr
Mesa, AZ 85201
Phone (480) 844-0011

NPI Registry JSON

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

{
    "created_epoch": "1293062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293062400000",
    "number": "1114221645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 N COUNTRY CLUB DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852014936",
            "telephone_number": "480-844-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 N COUNTRY CLUB DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852014936",
            "telephone_number": "480-844-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY'S MISSION AND DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-23",
        "last_updated": "2010-12-23",
        "status": "A",
        "authorized_official_last_name": "LACEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-844-0022",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "BH-3732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary's Mission Outpatient Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; 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.