I Care Group Home

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH5232 Issued in AZ

Legal business name

I CARE GROUP HOME

Practice address

5529 E Bloomfield Rd
Scottsdale, AZ 85254-4203

Phone

(480) 302-1620

NPI assigned

Aug 2, 2017

Organization subpart

No

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

Authorized official

Name

Elijah Sisse

Title

Program Director

Phone

(480) 302-1620

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501718400000",
    "number": "1619491495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 N 110TH DR",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853233323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5529 E BLOOMFIELD RD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852544203",
            "telephone_number": "480-302-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I CARE GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-02",
        "last_updated": "2017-08-03",
        "status": "A",
        "authorized_official_last_name": "SISSE",
        "authorized_official_first_name": "ELIJAH",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "480-302-1620"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH5232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2017; 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.