DW Developmental Homes LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

DW DEVELOPMENTAL HOMES LLC

Practice address

2609 North 107TH Ave
Avondale, AZ 85353

Phone

(951) 377-2710

NPI assigned

May 6, 2022

Last updated

May 6, 2022By 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

Simona Shallese Wilfred

Title

Ceo

Phone

(951) 377-2710

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1651795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651795200000",
    "number": "1467198010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9035 W GLOBE AVE",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853538642",
            "telephone_number": "951-377-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2609 NORTH 107TH AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "85353",
            "telephone_number": "951-377-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DW DEVELOPMENTAL HOMES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-06",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A",
        "authorized_official_last_name": "WILFRED",
        "authorized_official_first_name": "SIMONA",
        "authorized_official_middle_name": "SHALLESE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-377-2710"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000000",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.