Williams Sudan Guest Homes

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

BH-3215 Issued in AZ

Legal business name

WILLIAMS SUDAN GUEST HOMES

Practice address

15111 E Via de Olivos Rd
Chandler, AZ 85249-7423

Phone

(480) 751-7483

Fax

(480) 895-8399

NPI assigned

Jul 21, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Evelyn Willlliams

Title

Clinical Director

Phone

(480) 751-7483

Specialties & licenses 11

Addresses

Other identifiers 1

Other names 1

• Gleneagle Residential Care & Adult Day Treatment Services Doing business as

Tax ID family

Gleneagle Mental Health Agencies Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Gleneagle Mental Health Agencies Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Mesa, AZ
  • NPI 1013244813
  NPD tax ID

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

{
    "created_epoch": "1248134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248134400000",
    "number": "1295965531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4133 EAST GLENAGELE DR",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852497423",
            "telephone_number": "480-751-7483",
            "fax_number": "480-895-8399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15111 E VIA DE OLIVOS RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852497423",
            "telephone_number": "480-751-7483",
            "fax_number": "480-895-8399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMS SUDAN GUEST HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-21",
        "last_updated": "2009-07-21",
        "status": "A",
        "authorized_official_last_name": "WILLLLIAMS",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "480-751-7483",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "AZ",
            "license": "BBH-3215",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "BH-3215",
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "AZ",
            "license": "BH-3215",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "438547",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gleneagle Residential Care & Adult Day Treatment Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jake Alexander Wilkie
• Trever Lynn Wilkins, DO
• Tawna C Wilkinson, DPT, PT
• McKenzie Marie Wilks, PT, DPT
• William a Crum, O.D., P.L.C.
• Imani Najuma Williams-Vaughn, M.D.
• Andrea A Williams, OTR/L
• Ashley Nicole Williams
• Brandi Williams
• Brittany Nicole Williams

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2009; 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.