St. Michael's Manor

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

ALH-4384 Issued in AZ

Legal business name

ST. MICHAEL'S MANOR

Doing business as

TERESITA And MARIO CABACUNGAN

Practice address

8449 W Shaw Butte Dr
Peoria, AZ 85345-8160

Phone

(623) 486-5987

Fax

(623) 328-5530

NPI assigned

Nov 9, 2006

Last updated

May 31, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Teresita Arcena Cabacungan

Title

Owner

Phone

(562) 673-3214

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• TERESITA And MARIO CABACUNGAN Doing business as

Tax ID family

St Michael's Manor2 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.

• St. Michael's Manor

  • Adult Care Home Facility
  • Phoenix, AZ
  • NPI 1134950017
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• St. Michael's Manor

  • Adult Care Home Facility
  • Phoenix, AZ
  • NPI 1134950017
  NPPES parent name

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212192000000",
    "number": "1619047305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8449 W SHAW BUTTE DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853458160",
            "telephone_number": "623-486-5987",
            "fax_number": "623-328-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8449 W SHAW BUTTE DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853458160",
            "telephone_number": "623-486-5987",
            "fax_number": "623-328-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MICHAEL'S MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2008-05-31",
        "status": "A",
        "authorized_official_last_name": "CABACUNGAN",
        "authorized_official_first_name": "TERESITA",
        "authorized_official_middle_name": "ARCENA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-673-3214",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "AZ",
            "license": "ALH-4384",
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "AZ",
            "license": "ALH-5308",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "AZ",
            "license": "ALH6365",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "827777",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "966244",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TERESITA And MARIO CABACUNGAN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Annette Spychalla
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• Thimmavajjhala Sreecharana, M.D.
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• Kayla Marie Stacker, FNP
• Nicole S Stallworth
• Danika Marlynn Stampfel, M.S., CCC-SLP
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• Trena Melee Stansberry, RN

• Adult Care Home Facility in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Adult Care Home Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.