M & M Residential Home LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH5412 Issued in AZ

Legal business name

M & M RESIDENTIAL HOME LLC

Practice address

8572 W Palo Verde Ave
Peoria, AZ 85345-5354

Phone

(623) 249-3105

Fax

(623) 249-3105

NPI assigned

Apr 12, 2018

Last updated

Apr 12, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mavis Panford

Title

Program Director

Phone

(573) 855-1210

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1336646678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8572 W PALO VERDE AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853455354",
            "telephone_number": "623-249-3105",
            "fax_number": "623-249-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8572 W PALO VERDE AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853455354",
            "telephone_number": "623-249-3105",
            "fax_number": "623-249-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M & M RESIDENTIAL HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-12",
        "last_updated": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "PANFORD",
        "authorized_official_first_name": "MAVIS",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "573-855-1210"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH5412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Elizabeth Lyle, PA-C
• Lynch Vein and Aesthetics PLLC
• Matthew Lawrence Lynch, MD
• Ronald James Lynch, MC, LPC, LISAC, CSAT
• M & M Medical P.C.
• Veronica M High, PH.D.
• Cam Linh Ma
• Nicole Lorraine Maccleary Price, D.O.
• Darcy Machado, LCSW
• Emily Mack-Maulupe

• Mental Illness Community Based Residential Treatment Facility in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.