NPIMap

Organization Active NPI

Arizona Training Program - Earll

  • Intellectual Disabilities Intermediate Care Facility
  • Phoenix, AZ
National Provider Identifier
1306001052
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ARIZONA TRAINING PROGRAM - EARLL
Practice address
3043 N 37TH Street
Phoenix, AZ 85018
Phone
(602) 224-9986
NPI assigned
Jul 22, 2008
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF ARIZONAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Zane Garcia Ramadan
Title
Assistant Director
Phone
(480) 490-6538

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X AZ Primary

Addresses

Primary practice location

3043 N 37TH Street
Phoenix, AZ 85018

Mailing address

1789 W Jefferson St
Phoenix, AZ 85005
Phone (602) 542-6857

Other identifiers 1

IdentifierTypeStateIssuer
040030MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306001052. Details of each certification follow.

  • CCN 03G002 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 03G002

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ATP - EARLL
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jan 5, 1989
Last certification
May 15, 2025
Beds
12
Ownership / control type
State
Facility address
3043 North 37TH Street
Phoenix, AZ 85018

National Provider Directory

National Provider Directory
Tax ID family
Southern Arizona Mental32 organizations share this tax ID, including this one
Part of
Southern Arizona Mental

Other organizations with this tax ID 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1306001052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1789 W JEFFERSON ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85005",
            "telephone_number": "602-542-6857",
            "fax_number": "602-364-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3043 N 37TH STREET",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85018",
            "telephone_number": "602-224-9986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA TRAINING PROGRAM - EARLL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF ARIZONA",
        "enumeration_date": "2008-07-22",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "GARCIA RAMADAN",
        "authorized_official_first_name": "ZANE",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR",
        "authorized_official_telephone_number": "480-490-6538"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040030",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.