Individual provider Active NPI

Kodzo Honu

  • Mental Illness Community Based Residential Treatment Facility
  • Buckeye, AZ
National Provider Identifier
1225844319
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH10347 Issued in AZ
Practice address
5234 S 236TH Ave
Buckeye, AZ 85326-7284
Phone
(520) 585-7143
NPI assigned
Dec 4, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X BH10347 AZ
Mental Illness Community Based Residential Treatment Facility 320800000X BH10347 AZ Primary

Addresses

Primary practice location

5234 S 236TH Ave
Buckeye, AZ 85326-7284

Mailing address

4000 N Central Ave Ste 100
Phoenix, AZ 85012-3520
Phone (602) 859-7794

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

LicenseStateTypeSpecialty
BH10347AZMDMental Illness Community Based Residential Treatment Facility

Practice roles

OrganizationSpecialtyStatusNew patients
The Devereux Foundation CurrentSince Dec 8, 2024 Accepting new patients

Locations

4000 N Central Ave
Ste 100
Phoenix, AZ 85012
Phone (602) 896-3106

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1225844319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 N CENTRAL AVE STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850123520",
            "telephone_number": "602-859-7794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5234 S 236TH AVE",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853267284",
            "telephone_number": "520-585-7143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HONU",
        "first_name": "KODZO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "AZ",
            "license": "BH10347",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH10347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buckeye, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; 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.