Active NPI
Kelly Megahan
- Mental Illness Community Based Residential Treatment Facility
- Parks, AZ
National Provider Identifier
1346660602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- 3092313
- Practice address
- 3011 S Sycamore Canyon Drive
Parks, AZ 86018-0304 - Phone
- (928) 853-4152
- NPI assigned
- Apr 24, 2014
- Last updated
- Apr 24, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 3092313 | AZ | Primary |
Addresses
Primary practice location
3011 S Sycamore Canyon Drive
Parks, AZ 86018-0304
Mailing address
PO Box 50304
Parks, AZ 86018-0304
Phone (928) 853-4152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3092313 | AZ | MD | Mental Illness Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398297600000",
"number": "1346660602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 50304",
"city": "PARKS",
"state": "AZ",
"postal_code": "860180304",
"telephone_number": "928-853-4152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3011 S SYCAMORE CANYON DRIVE",
"city": "PARKS",
"state": "AZ",
"postal_code": "860180304",
"telephone_number": "928-853-4152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEGAHAN",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-04-24",
"last_updated": "2014-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "AZ",
"license": "3092313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Parks, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.