NPIMap

Organization Active NPI

Faith Behavioral Health Group, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Goodyear, AZ
National Provider Identifier
1194312876
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
FAITH BEHAVIORAL HEALTH GROUP, LLC
Practice address
17870 W Buchanan St
Goodyear, AZ 85338-2582
Phone
(623) 600-8822
Fax
(623) 600-8822
NPI assigned
Dec 28, 2020
Organization subpart
Yes
Parent organization
FAITH BEHAVIORAL HEALTH GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Authorized official

Name
Mrs. Mary K Kiilu, RNNPI 1811310808
Title
Official
Phone
(909) 441-9520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

17870 W Buchanan St
Goodyear, AZ 85338-2582

Mailing address

17870 W Buchanan St
Goodyear, AZ 85338-2582
Phone (623) 600-8822

Other names 1

  • FAITH BEHAVIORAL HEALTH GROUP, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Faith Behavioral Health Group LLC2 organizations share this tax ID, including this one
Part of
Faith Behavioral Health Group LLC

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1609113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1194312876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17870 W BUCHANAN ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853382582",
            "telephone_number": "623-600-8822",
            "fax_number": "623-600-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17870 W BUCHANAN ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853382582",
            "telephone_number": "623-600-8822",
            "fax_number": "623-600-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH BEHAVIORAL HEALTH GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAITH BEHAVIORAL HEALTH GROUP, LLC",
        "enumeration_date": "2020-12-28",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "KIILU",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICIAL",
        "authorized_official_telephone_number": "909-441-9520",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAITH BEHAVIORAL HEALTH GROUP, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAITH BEHAVIORAL HEALTH GROUP, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.