Centro de Amistad, Incorporado

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

BH-3759 Issued in AZ

Legal business name

CENTRO DE AMISTAD, INCORPORADO

Practice address

2923 N 33Rd Ave
Phoenix, AZ 85017-5201

Phone

(602) 393-3840

Fax

(602) 393-3842

NPI assigned

Nov 13, 2006

Last updated

Dec 7, 2010By 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

Rita Monroy

Title

President and Ceo

Phone

(480) 839-2926

Specialties & licenses 1

Addresses

Other identifiers 5

Tax ID family

Centro de Amistad Incorporado3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Centro de Amistad, Incorporado

  • Community/Behavioral Health Agency
  • Mesa, AZ
  • NPI 1073684791
  NPD tax ID
• Centro de Amistad, Incorprorado

  • Community/Behavioral Health Agency
  • Guadalupe, AZ
  • NPI 1497826101
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adimika M Smith, LCSW

  • Clinical Social Worker
  • NPI 1568633667
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291680000000",
    "number": "1467523183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8202 S AVENIDA DEL YAQUI",
            "city": "GUADALUPE",
            "state": "AZ",
            "postal_code": "852831024",
            "telephone_number": "480-839-2926",
            "fax_number": "480-839-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2923 N 33RD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850175201",
            "telephone_number": "602-393-3840",
            "fax_number": "602-393-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE AMISTAD, INCORPORADO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2010-12-07",
        "status": "A",
        "authorized_official_last_name": "MONROY",
        "authorized_official_first_name": "RITA",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "480-839-2926"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "BH-3759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VO BILLING NUMBER",
            "identifier": "1062007",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER NO.",
            "identifier": "957409",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ BH LICENSE NO.",
            "identifier": "BH-2504",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN MIS#",
            "identifier": "600252357",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHS VENDOR NO.",
            "identifier": "A004334",
            "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 Dec 7, 2010; 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.