Moms House of Az LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

MOMS HOUSE OF AZ LLC

Practice address

3636 N 3Rd Ave Ste 150
Phoenix, AZ 85013-3943

Phone

(510) 386-0713

NPI assigned

May 12, 2020

Organization subpart

No

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

Authorized official

Name

Jarel Hall

Title

Owner

Phone

(510) 368-0713

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1366064438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 N 3RD AVE STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133943",
            "telephone_number": "510-386-0713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 N 3RD AVE STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133943",
            "telephone_number": "510-386-0713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMS HOUSE OF AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "JAREL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "510-368-0713"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucretia Molzahn, LAC
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• Momm
• Debra Momon, L.P.N.
• Momsultant LLC
• Jane H Monachelli
• Katelyn H Monaco, COTA
• Malia Monaco
• Regina Monaco, PT, DPT

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; 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.