NPIMap

Organization Active NPI

San Carlos Wellness Center

  • Addiction (Substance Use Disorder) Counselor
  • Bylas, AZ
National Provider Identifier
1134255136
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
10845 Issued in AZ
Legal business name
SAN CARLOS WELLNESS CENTER
Practice address
154 E. Hwy 70
Bylas, AZ 85530
Phone
(928) 475-3450
Fax
(928) 475-3453
NPI assigned
Feb 26, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Dr. Ahmad Djangi, PSYD
Title
Program Manager
Phone
(928) 475-4875

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 10845 AZ Primary

Addresses

Primary practice location

154 E. Hwy 70
Bylas, AZ 85530

Mailing address

5 San Carlos Boulevard
San Carlos, AZ 85550
Phone (928) 478-4875

National Provider Directory

National Provider Directory
Tax ID family
San Carlos Apache Tribe7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1134255136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SAN CARLOS BOULEVARD",
            "city": "SAN CARLOS",
            "state": "AZ",
            "postal_code": "85550",
            "telephone_number": "928-478-4875",
            "fax_number": "928-475-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 E. HWY 70",
            "city": "BYLAS",
            "state": "AZ",
            "postal_code": "85530",
            "telephone_number": "928-475-3450",
            "fax_number": "928-475-3453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN CARLOS WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DJANGI",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "928-475-4875",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "10845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bylas, 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.