NPIMap

Organization Active NPI

Springbrook Habilitation Services, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1336310275
Registry record updated Dec 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH-2586 Issued in AZ
Legal business name
SPRINGBROOK HABILITATION SERVICES, LLC
Practice address
3843 E Larkspur Dr
Phoenix, AZ 85032-7345
Phone
(602) 595-3025
Fax
(602) 595-6029
NPI assigned
Mar 19, 2008
Last updated
Dec 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2009

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

Authorized official

Name
Mr. George W Green Jr., M.ED.
Title
Clinical Director
Phone
(602) 424-1838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH-2586 AZ Primary

Addresses

Primary practice location

3843 E Larkspur Dr
Phoenix, AZ 85032-7345

Mailing address

4835 E Cactus Rd
Suite # 460
Scottsdale, AZ 85254-4191
Phone (602) 424-1838

Other identifiers 1

IdentifierTypeStateIssuer
701418MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Springbrook Habilitation Services LLC4 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.

Locations

4835 E Cactus Rd
Ste 460
Scottsdale, AZ 85254
Phone (602) 424-1838

NPI Registry JSON

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1336310275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 E CACTUS RD",
            "address_2": "SUITE # 460",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852544191",
            "telephone_number": "602-424-1838",
            "fax_number": "602-424-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3843 E LARKSPUR DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850327345",
            "telephone_number": "602-595-3025",
            "fax_number": "602-595-6029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGBROOK HABILITATION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "602-424-1838",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.ED."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH-2586",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "701418",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.