Mattie'S Care House, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH4867 Issued in AZ

Legal business name

MATTIE'S CARE HOUSE, LLC

Practice address

6823 W Pleasant LN
Laveen, AZ 85339-2660

Phone

(602) 686-0419

Fax

(602) 687-9742

NPI assigned

Jun 30, 2016

Organization subpart

No

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

Authorized official

Name

Latoya J. Lee

Title

Ceo/Administrator

Phone

(602) 686-0419

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Mattie'S Care House LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mattie'S Care House, LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Phoenix, AZ
  • NPI 1467292086
  NPD tax ID

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1447601448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6823 W PLEASANT LN",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853392660",
            "telephone_number": "602-686-0419",
            "fax_number": "602-687-9742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6823 W PLEASANT LN",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853392660",
            "telephone_number": "602-686-0419",
            "fax_number": "602-687-9742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTIE'S CARE HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-30",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "LATOYA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "602-686-0419"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "148847",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Irene Basil Maseveriyo
• Breannea Mason
• Tinoy Matamana, PT
• Mateenah'S Manor Assisted Living Homes, LLC
• Michaela Mathis, PMHNP-BC
• Mave Care Behavioral Health LLC
• Marta Mayes
• Carmalita McClelland, LPN
• Kiara McCoy
• Caitlyn B McCrain, LMSW

• Mental Illness Community Based Residential Treatment Facility in Laveen, AZ
• Providers in Laveen, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; 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.