NPIMap

Organization Active NPI

Mary Group Home LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Laveen, AZ
National Provider Identifier
1619590478
Registry record updated May 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
MARY GROUP HOME LLC
Practice address
8025 S 47TH LN
Laveen, AZ 85339-2393
Phone
(480) 577-7777
NPI assigned
May 27, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2020

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

Authorized official

Name
Reem Naeum Naeum
Title
Owner
Phone
(623) 565-0010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

8025 S 47TH LN
Laveen, AZ 85339-2393

Mailing address

348 S Park Grove LN
Gilbert, AZ 85296-1731

National Provider Directory

National Provider Directory
Tax ID family
Mary Group Home LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1590537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590537600000",
    "number": "1619590478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "348 S PARK GROVE LN",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852961731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8025 S 47TH LN",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853392393",
            "telephone_number": "480-577-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-27",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A",
        "authorized_official_last_name": "NAEUM",
        "authorized_official_first_name": "REEM",
        "authorized_official_middle_name": "NAEUM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-565-0010"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laveen, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; 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.