Northwest Organization for Voluntary Alternatives

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

BH 406 Issued in AZ

Legal business name

NORTHWEST ORGANIZATION FOR VOLUNTARY ALTERNATIVES

Doing business as

DBA: Maverick House

Practice address

5801 North 51St Avenue Suite 109
Glendale, AZ 85301

Phone

(623) 931-5810

Fax

(623) 931-1302

NPI assigned

Oct 2, 2007

Last updated

Apr 7, 2014By 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

Mr. Edward William Pinnow

Title

Acting Director

Phone

(623) 937-9203

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DBA: Maverick House Doing business as

Locations

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396828800000",
    "number": "1437346517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 WEST OLIVE AVENUE SUITE 200",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85302",
            "telephone_number": "623-937-9203",
            "fax_number": "623-930-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 NORTH 51ST AVENUE SUITE 109",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85301",
            "telephone_number": "623-931-5810",
            "fax_number": "623-931-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ORGANIZATION FOR VOLUNTARY ALTERNATIVES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2014-04-07",
        "status": "A",
        "authorized_official_last_name": "PINNOW",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "ACTING DIRECTOR",
        "authorized_official_telephone_number": "623-937-9203",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH 406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "346058",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA: Maverick House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; 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.