NPIMap

Organization Active NPI

Mount Lemmon Healthcare LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Tucson, AZ
National Provider Identifier
1477324853
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
MOUNT LEMMON HEALTHCARE LLC
Doing business as
Villa Maria Detox
Practice address
4310 E Grant Rd Ste B
Tucson, AZ 85712-2607
Phone
(520) 323-2607
Fax
(520) 323-4087
NPI assigned
Jan 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

4310 E Grant Rd Ste B
Tucson, AZ 85712-2607

Mailing address

4310 E Grant Rd Ste B
Tucson, AZ 85712-2607
Phone (520) 323-2607

Other names 1

  • Villa Maria Detox Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mount Lemmon Healthcare LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

4310 E Grant Rd
Ste B
Tucson, AZ 85712
Phone (520) 323-2607

NPI Registry JSON

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1477324853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 E GRANT RD STE B",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122607",
            "telephone_number": "520-323-2607",
            "fax_number": "520-323-4087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 E GRANT RD STE B",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122607",
            "telephone_number": "520-323-2607",
            "fax_number": "520-323-4087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT LEMMON HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Villa Maria Detox",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.