NPIMap

Organization Active NPI

Superstition Manor Assisted Living LLC

  • Health Maintenance Organization
  • Apache Junction, AZ
National Provider Identifier
1609201128
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
SUPERSTITION MANOR ASSISTED LIVING LLC
Practice address
201 W 20TH Ave
Apache Junction, AZ 85120-7532
Phone
(480) 227-3458
NPI assigned
Sep 4, 2013
Last updated
Sep 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Authorized official

Name
Bruce Bogucki
Title
Owner/Member
Phone
(480) 227-3458

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Primary

Addresses

Primary practice location

201 W 20TH Ave
Apache Junction, AZ 85120-7532

Mailing address

201 W 20TH Ave
Apache Junction, AZ 85120-7532
Phone (480) 227-3458

National Provider Directory

National Provider Directory
Tax ID family
Superstition Manor Assisted Living LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378252800000",
    "number": "1609201128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W 20TH AVE",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851207532",
            "telephone_number": "480-227-3458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W 20TH AVE",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851207532",
            "telephone_number": "480-227-3458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERSTITION MANOR ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-04",
        "last_updated": "2013-09-04",
        "status": "A",
        "authorized_official_last_name": "BOGUCKI",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "480-227-3458"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apache Junction, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; 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.