NPIMap

Organization Active NPI

Springbrook Habilitation Services, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1154592095
Registry record updated Dec 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH-3021 Issued in AZ
Legal business name
SPRINGBROOK HABILITATION SERVICES, LLC
Practice address
3058 W Grandview Rd
Phoenix, AZ 85053-3070
Phone
(602) 795-6905
Fax
(602) 795-6907
NPI assigned
Mar 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2009

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

Authorized official

Name
Mr. George W Green Jr., M.ED.
Title
Clinical Director
Phone
(602) 424-1838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH-3021 AZ Primary

Addresses

Primary practice location

3058 W Grandview Rd
Phoenix, AZ 85053-3070

Mailing address

4835 E Cactus Rd
Suite 460
Scottsdale, AZ 85254-4191
Phone (602) 424-1838

Other identifiers 1

IdentifierTypeStateIssuer
856122MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Springbrook Habilitation Services LLC4 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": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1154592095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 E CACTUS RD",
            "address_2": "SUITE 460",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852544191",
            "telephone_number": "602-424-1838",
            "fax_number": "602-424-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3058 W GRANDVIEW RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850533070",
            "telephone_number": "602-795-6905",
            "fax_number": "602-795-6907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGBROOK HABILITATION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "602-424-1838",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.ED."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH-3021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "856122",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; 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.