Sun State Behavioral, LLC

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

Legal business name

SUN STATE BEHAVIORAL, LLC

Practice address

9525 W Minnezona Ave
Phoenix, AZ 85037-1349

Phone

(623) 872-5454

NPI assigned

Oct 5, 2021

Organization subpart

No

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

Authorized official

Name

Justin MabanyNPI 1033886338

Title

Chief Executive Officer

Phone

(602) 384-0669

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin Mabany

  • Assisted Living Facility (Behavioral Disturbances)
  • Phoenix, AZ
  • NPI 1033886338

  Assisted Living, Behavioral Disturbances

  NPD Authorized official

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1619649845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9525 W MINNEZONA AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850371349",
            "telephone_number": "623-872-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9525 W MINNEZONA AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850371349",
            "telephone_number": "623-872-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN STATE BEHAVIORAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "MABANY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "602-384-0669"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Other",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9525 W Minnezona Ave",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850371349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Assisted Living Facility (Behavioral Disturbances) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Assisted Living Facility (Behavioral Disturbances) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.