Salim Otieno Odiero

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH5615 Issued in AZ

Practice address

9138 E Dennis St
Mesa, AZ 85207-6008

Phone

(480) 380-4413

Fax

(480) 530-5408

NPI assigned

Sep 21, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mon Ami 2 Group Home LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Maricopa, AZ
  • NPI 1255061032
  NPD Authorized official
• Mon Ami Group Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Mesa, AZ
  • NPI 1013481993
  NPD Authorized official
• Mon Ami Group Home

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesa, AZ
  • NPI 1215588629
  NPD Authorized official

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1144836669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9138 E DENNIS ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852076008",
            "telephone_number": "480-380-4413",
            "fax_number": "480-530-5408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9138 E DENNIS ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852076008",
            "telephone_number": "480-380-4413",
            "fax_number": "480-530-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODIERO",
        "first_name": "SALIM",
        "middle_name": "OTIENO",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-21",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH5615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "465372",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thaddeo Consunji Oconer, MD
• Ocotillo Hospital and Surgical Services, LLC
• Ocotillo Sleep Solutions LLC
• Oluwagbemiga Odede, NP
• Jill Odgren-Cole, N.D.
• Harold Odutola, PA
• Odyssey Services Corp.
• Meredith Oehler, LPC
• Elizabeth Sarah Oehrlein, PA-C
• Ronald A Ogara, DC

• Mental Illness Community Based Residential Treatment Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.