Cap X-Montecito

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

CAP X-MONTECITO

Practice address

17271 N 87TH Ave
Peoria, AZ 85382-2777

Phone

(623) 972-1400

Fax

(623) 972-7470

NPI assigned

Aug 27, 2024

Organization subpart

No

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

Authorized official

Name

Deatra Johnson

Title

Executive Director

Phone

(623) 972-1400

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1609600105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17271 N 87TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822777",
            "telephone_number": "623-972-1400",
            "fax_number": "623-972-7470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17271 N 87TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822777",
            "telephone_number": "623-972-1400",
            "fax_number": "623-972-7470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAP X-MONTECITO",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DEATRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "623-972-1400"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Custodial Care Facility in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Custodial Care Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.