NPIMap

Organization Active NPI

Mingus Mountain Estate Residential Center Inc

  • Assisted Living Facility (Behavioral Disturbances)
  • Prescott Valley, AZ
National Provider Identifier
1497828503
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X
License
BH-1487 Issued in AZ
Legal business name
MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC
Practice address
3801 N Robert Rd
Prescott Valley, AZ 86314-8107
Phone
(602) 335-2095
Fax
(602) 249-1311
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Authorized official

Name
Brooke Wilson
Title
Senior Credentialing Specialist
Phone
(602) 335-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Behavioral Disturbances) 3104A0630X BH-1487 AZ Primary

Addresses

Primary practice location

3801 N Robert Rd
Prescott Valley, AZ 86314-8107

Mailing address

2517 N Great Western Dr
Prescott Valley, AZ 86314-2597
Phone (602) 335-2000

Other identifiers 1

IdentifierTypeStateIssuer
498057MedicaidAZ

Other names 1

  • Emily House Other name

National Provider Directory

National Provider Directory
Tax ID family
Mingus Mountain Estate Residential Center Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

2517 N Great Western Dr
Prescott Valley, AZ 86314
Phone 9284451341 ext. 239

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1497828503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2517 N GREAT WESTERN DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142597",
            "telephone_number": "602-335-2000",
            "fax_number": "480-534-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 N ROBERT RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863148107",
            "telephone_number": "602-335-2095",
            "fax_number": "602-249-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINGUS MOUNTAIN ESTATE RESIDENTIAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "602-335-2000"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "AZ",
            "license": "BH-1487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "498057",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emily House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; 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.