Active NPI
Kodzo Honu
- Mental Illness Community Based Residential Treatment Facility
- Buckeye, AZ
National Provider Identifier
1225844319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- BH10347
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| BH10347 | AZ | MD | Mental Illness Community Based Residential Treatment Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Devereux Foundation | Current | 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.
-
- Adolescent and Children Mental Health Clinic/Center
- Phoenix, AZ
- NPI 1306939368
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.