The Watkins Home

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

BH4267 Issued in AZ

Legal business name

THE WATKINS HOME

Doing business as

The Watkins Home

Practice address

15372 W Roanoke Ave
Goodyear, AZ 85395-8980

Phone

(623) 535-5533

Fax

(623) 535-6666

NPI assigned

Jan 25, 2007

Last updated

Jun 12, 2013By 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

Mrs. Yvonne Ann Watkins

Title

Administrator

Phone

(623) 535-5533

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• The Watkins Home Doing business as

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370995200000",
    "number": "1396890620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15372 W ROANOKE AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853958980",
            "telephone_number": "623-535-5533",
            "fax_number": "623-535-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15372 W ROANOKE AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853958980",
            "telephone_number": "623-535-5533",
            "fax_number": "623-535-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WATKINS HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2013-06-12",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "623-535-5533",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "AZ",
            "license": "BH4267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OBHL LICENSE",
            "identifier": "BH2622",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "941147",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE OF BEHAVIORAL HEALTH LICENSE NUMBER",
            "identifier": "BH3584",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Watkins Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kimberly Ann Thompson, APRN
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• Exclusive Provider Organization in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Exclusive Provider Organization in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; 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.