Active NPI
Loloma Houses LLC
- Community/Behavioral Health Agency
- Glendale, AZ
National Provider Identifier
1407482268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- LOLOMA HOUSES LLC
- Doing business as
- Loloma House at Greenway
Loloma House at Sunnyside - Practice address
- 6125 W Sunnyside Dr
Glendale, AZ 85304-2533 - Phone
- (623) 418-6657
- NPI assigned
- Mar 12, 2020
- Organization subpart
- Yes
- Parent organization
- LOLOMA HOUSE LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Laura Adiloba Hornback
- Title
- Owner / Administrator
- Phone
- (623) 418-6657
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
6125 W Sunnyside Dr
Glendale, AZ 85304-2533
Mailing address
8408 W Willow Ave
Peoria, AZ 85381-4864
Phone (623) 418-6657
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942743711 | Medicaid | AZ |
Other names 2
- Loloma House at Greenway
- Loloma House at Sunnyside
National Provider Directory
National Provider Directory- Part of
- Loloma House LLC
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Mental Health Counselor
- Peoria, AZ
- NPI 1093188138
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583971200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1585267200000",
"number": "1407482268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8408 W WILLOW AVE",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853814864",
"telephone_number": "623-418-6657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6125 W SUNNYSIDE DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853042533",
"telephone_number": "623-418-6657"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LOLOMA HOUSES LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LOLOMA HOUSE LLC",
"enumeration_date": "2020-03-12",
"last_updated": "2020-03-27",
"certification_date": "2020-03-27",
"status": "A",
"authorized_official_last_name": "HORNBACK",
"authorized_official_first_name": "LAURA",
"authorized_official_middle_name": "ADILOBA",
"authorized_official_title_or_position": "OWNER / ADMINISTRATOR",
"authorized_official_telephone_number": "623-418-6657",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1942743711",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Loloma House at Greenway",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Loloma House at Greenway",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Loloma House at Sunnyside",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.