San Judas Group Home

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

ALH6076 Issued in AZ

Legal business name

SAN JUDAS GROUP HOME

Practice address

5116 S 11TH Ave
Phoenix, AZ 85041-2363

Phone

(602) 643-5932

Fax

(602) 281-6974

NPI assigned

Apr 7, 2010

Organization subpart

No

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

Authorized official

Name

Imelda Melissa Noriega

Title

Administrator

Phone

(602) 643-5932

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1386969947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5415 S 5TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850414000",
            "telephone_number": "602-643-5932",
            "fax_number": "602-281-6974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5116 S 11TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850412363",
            "telephone_number": "602-643-5932",
            "fax_number": "602-281-6974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUDAS GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-07",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "NORIEGA",
        "authorized_official_first_name": "IMELDA MELISSA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "602-643-5932"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "AZ",
            "license": "ALH6076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203799",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lorraine Samuel
• Suzana Marcella Samuel, MD
• Jody Leona Samuelson, DC
• Robert Samuelson
• Robin San George
• San Tan Eyecare - Paradise Valley, PLLC
• San Tan Foot and Ankle
• San Tan Orthopedics, PLC
• Sana Health and Wellness LLC
• Sana Vida Psychiatry

• Physical Disabilities Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Disabilities Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; 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.