The Eagle Watch BHS Quintana

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

BH4705 Issued in AZ

Legal business name

THE EAGLE WATCH BHS QUINTANA

Doing business as

Quintana

Practice address

4145 E Megan St
Gilbert, AZ 85295-7736

Phone

(602) 369-2609

Fax

(480) 207-1420

NPI assigned

Apr 18, 2016

Last updated

May 26, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

THE EAGLE WATCH BHS LLCAs reported in NPPES

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

Authorized official

Name

Mr. John M Kamau, ADMIN

Title

Administrator

Phone

(602) 369-2609

Specialties & licenses 1

Addresses

Other names 1

• Quintana Doing business as

Tax ID family

The Eagle-Watch Behavioral Health Services LLC2 organizations share this tax ID, including this one

Part of

The Eagle-Watch Behavioral Health Services LLC

Other organizations with this tax ID 1

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

• The Eagle-Watch Behavioral Health Services LLC

  dba Gemstone

  • Preferred Provider Organization
  • Gilbert, AZ
  • NPI 1437565389
  NPD tax ID

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

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1497109292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4145 E MEGAN ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852957736",
            "telephone_number": "602-369-2609",
            "fax_number": "480-207-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4145 E MEGAN ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852957736",
            "telephone_number": "602-369-2609",
            "fax_number": "480-207-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EAGLE WATCH BHS QUINTANA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE EAGLE WATCH BHS LLC",
        "enumeration_date": "2016-04-18",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "KAMAU",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "602-369-2609",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ADMIN"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "AZ",
            "license": "BH4705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quintana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility (Behavioral Disturbances) in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Assisted Living Facility (Behavioral Disturbances) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.