Active NPI
Amanda Ellis
- Physical Disabilities Residential Treatment Facility
- San Tan Valley, AZ
National Provider Identifier
1194198697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Disabilities Residential Treatment Facility
- License
- D05686544
- Practice address
- 381 East Brook Street
San Tan Valley, AZ 85140 - Phone
- (480) 495-2839
- NPI assigned
- Nov 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Disabilities Residential Treatment Facility | 320700000X | D05686544 | AZ | Primary |
Addresses
Primary practice location
381 East Brook Street
San Tan Valley, AZ 85140
Mailing address
381 E Brook St
San Tan Valley, AZ 85140
Phone (480) 495-2839
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D05686544 | AZ | MD | Physical Disabilities Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446681600000",
"number": "1194198697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "381 E BROOK ST",
"city": "SAN TAN VALLEY",
"state": "AZ",
"postal_code": "85140",
"telephone_number": "480-495-2839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "381 EAST BROOK STREET",
"city": "SAN TAN VALLEY",
"state": "AZ",
"postal_code": "85140",
"telephone_number": "480-495-2839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-05",
"last_updated": "2015-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "320700000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Physical Disabilities",
"state": "AZ",
"license": "D05686544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Tan Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.