NPIMap

Organization Active NPI

La Paloma Family Services

Doing business as Evergreen Facility

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Tucson, AZ
National Provider Identifier
1265512776
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
BH-613 Issued in AZ
Legal business name
LA PALOMA FAMILY SERVICES
Doing business as
Evergreen Facility
Practice address
4321 S Evergreen Ave
Tucson, AZ 85730-4005
Phone
(520) 750-8679
Fax
(520) 750-0056
NPI assigned
Oct 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Mr. David T Bradley
Title
Cfo
Phone
(520) 750-9667

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X BH-613 AZ Primary

Addresses

Primary practice location

4321 S Evergreen Ave
Tucson, AZ 85730-4005

Mailing address

880 S Craycroft Rd
Tucson, AZ 85711-7111
Phone (520) 750-9667

Other names 1

  • Evergreen Facility Doing business as

National Provider Directory

National Provider Directory
Tax ID family
La Paloma Family Services13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265512776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 S CRAYCROFT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857117111",
            "telephone_number": "520-750-9667",
            "fax_number": "520-750-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 S EVERGREEN AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857304005",
            "telephone_number": "520-750-8679",
            "fax_number": "520-750-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PALOMA FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "520-750-9667",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH-613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, 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.