NPIMap

Organization Active NPI

La Paloma Family Services

Doing business as Fairview LII Group Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Tucson, AZ
National Provider Identifier
1518142033
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
BH3029 Issued in AZ
Legal business name
LA PALOMA FAMILY SERVICES
Doing business as
Fairview LII Group Home
Practice address
870 W Miracle Mile BLDG 2
Tucson, AZ 85705-3708
Phone
(520) 750-9667
Fax
(520) 750-0056
NPI assigned
Jan 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

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

Authorized official

Name
Mr. David Bradley
Title
Ceo
Phone
(520) 750-9667

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X BH3029 AZ Primary

Addresses

Primary practice location

870 W Miracle Mile BLDG 2
Tucson, AZ 85705-3708

Mailing address

870 W Miracle Mile
Tucson, AZ 85705-3708
Phone (520) 750-9667

Other identifiers 1

IdentifierTypeStateIssuer
APPLIEDMedicaidAZ

Other names 1

  • Fairview LII Group Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
La Paloma Family Services13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

870 W Miracle Mile
Bldg 2
Tucson, AZ 85705
Phone (520) 750-9667

NPI Registry JSON

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

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1518142033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 W MIRACLE MILE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857053708",
            "telephone_number": "520-750-9667",
            "fax_number": "520-750-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 W MIRACLE MILE BLDG 2",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857053708",
            "telephone_number": "520-750-9667",
            "fax_number": "520-750-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PALOMA FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-750-9667",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH3029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "APPLIED",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairview LII Group Home",
            "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 3, 2008; 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.