NPIMap

Organization Active NPI

Legacy Village of East Mesa

  • Mental Illness Community Based Residential Treatment Facility
  • Mesa, AZ
National Provider Identifier
1437377207
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
ALC5776 Issued in AZ
Legal business name
LEGACY VILLAGE OF EAST MESA
Practice address
5037 E. Broadway
Mesa, AZ 85206
Phone
(480) 924-4073
Fax
(480) 396-0191
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Robert Thomas Bartel
Title
Director
Phone
(480) 924-4073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X ALC5776 AZ Primary

Addresses

Primary practice location

5037 E. Broadway
Mesa, AZ 85206

Mailing address

5037 E Broadway Rd
Mesa, AZ 85206-1301
Phone (480) 924-4073

National Provider Directory

National Provider Directory
Tax ID family
Copper Heights4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5037 E Broadway Rd
Mesa, AZ 85206
Phone (480) 924-4073

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437377207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5037 E BROADWAY RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061301",
            "telephone_number": "480-924-4073",
            "fax_number": "480-396-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5037 E. BROADWAY",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85206",
            "telephone_number": "480-924-4073",
            "fax_number": "480-396-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY VILLAGE OF EAST MESA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BARTEL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "480-924-4073",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "ALC5776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.