Exclusive Certified Residential Care, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH4985 Issued in AZ

Legal business name

EXCLUSIVE CERTIFIED RESIDENTIAL CARE, LLC

Practice address

3744 Martingale Dr
Kingman, AZ 86409-2994

Phone

(928) 255-1747

Fax

(928) 255-1741

NPI assigned

Oct 12, 2016

Last updated

Oct 12, 2016By 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

Maya RoyceNPI 1639628936

Title

Owner

Phone

(623) 285-9595

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maya Royce

  • Behavior Technician
  • Kingman, AZ
  • NPI 1639628936
  NPD (past) Authorized official

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1629528716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33105 N 23RD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850855088",
            "telephone_number": "623-285-9595",
            "fax_number": "928-255-1741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3744 MARTINGALE DR",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864092994",
            "telephone_number": "928-255-1747",
            "fax_number": "928-255-1741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCLUSIVE CERTIFIED RESIDENTIAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "ROYCE",
        "authorized_official_first_name": "MAYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-285-9595"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juvy Escalante, PA
• Lindsay J Escobedo, DO, ND, MBA
• Berenice Jeacel Espinoza, FNP, RN
• Patricia Rae Evans, M.D.
• Exceptional Employment Services L.L.C.
• Ashley Marie Eyer
• Keiko Sato Fakhraie, D.O.
• Family Dentistry by Design
• Amir Farid, MD
• Rauchel Chelan Farris

• Mental Illness Community Based Residential Treatment Facility in Kingman, AZ
• Providers in Kingman, 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 Oct 12, 2016; 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.