NPIMap

Organization Active NPI

Eureka Imperial Residence

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gilbert, AZ
National Provider Identifier
1649798752
Registry record updated Sep 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
EUREKA IMPERIAL RESIDENCE
Practice address
633 E Ray Road
Gilbert, AZ 85295
Phone
(480) 264-2647
NPI assigned
Sep 8, 2017
Organization subpart
Yes
Parent organization
EUREKA IMPERIAL RESIDENCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2017

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

Authorized official

Name
Cornelius Tanyi
Title
Program Director
Phone
(480) 264-2647

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

633 E Ray Road
Gilbert, AZ 85295

Mailing address

633 E Ray Rd
Gilbert, AZ 85296-4200

Other names 1

  • CHANGING LIVES OUTPATIENT CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eureka Imperial Residence 34 organizations share this tax ID, including this one
Part of
Eureka Imperial Residence 3

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504828800000",
    "number": "1649798752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 E RAY RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 E RAY ROAD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85295",
            "telephone_number": "480-264-2647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUREKA IMPERIAL RESIDENCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EUREKA IMPERIAL RESIDENCE",
        "enumeration_date": "2017-09-08",
        "last_updated": "2017-09-08",
        "status": "A",
        "authorized_official_last_name": "TANYI",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "480-264-2647"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHANGING LIVES OUTPATIENT CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.