NPIMap

Organization Active NPI

Big John Group Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • El Mirage, AZ
National Provider Identifier
1255484366
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
723636 Issued in AZ
Legal business name
BIG JOHN GROUP HOME
Practice address
12514 N 126TH LN
El Mirage, AZ 85335-5206
Phone
(480) 202-2972
Fax
(623) 546-0161
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Stephanie Kay Edwards
Title
Director of Operations
Phone
(480) 202-2972

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 723636 AZ Primary

Addresses

Primary practice location

12514 N 126TH LN
El Mirage, AZ 85335-5206

Mailing address

70 S Val Vista Dr Ste A3 # 44
Gilbert, AZ 85296-1375
Phone (480) 202-2972

National Provider Directory

National Provider Directory
Tax ID family
Big John Group Home4 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": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255484366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 S VAL VISTA DR STE A3 # 44",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852961375",
            "telephone_number": "480-202-2972",
            "fax_number": "623-546-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12514 N 126TH LN",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853355206",
            "telephone_number": "480-202-2972",
            "fax_number": "623-546-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG JOHN GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "480-202-2972"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "723636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Mirage, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.