NPIMap

Organization Active NPI

Joondalup Prestige LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Laveen, AZ
National Provider Identifier
1356086037
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
JOONDALUP PRESTIGE LLC
Doing business as
Joondalup Prestige, LLC
Practice address
4602 W Donner Dr
Laveen, AZ 85339-4264
Phone
(858) 344-4746
Fax
(520) 455-3200
NPI assigned
Apr 28, 2022
Last updated
Apr 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Mercy Wendy MuthoniNPI 1922693480
Title
Administrator
Phone
(858) 344-4746

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary

Addresses

Primary practice location

4602 W Donner Dr
Laveen, AZ 85339-4264

Mailing address

8509 S 41St Dr
Laveen, AZ 85339-7823
Phone (858) 344-4746

Other names 1

  • Joondalup Prestige, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Joondalup Prestige LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1651104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1356086037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8509 S 41ST DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853397823",
            "telephone_number": "858-344-4746",
            "fax_number": "520-455-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4602 W DONNER DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853394264",
            "telephone_number": "858-344-4746",
            "fax_number": "520-455-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOONDALUP PRESTIGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-28",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "MUTHONI",
        "authorized_official_first_name": "MERCY",
        "authorized_official_middle_name": "WENDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "858-344-4746"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Joondalup Prestige, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laveen, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.