Active NPI
Kellie L Cardoza, BHT
- Day Training/Habilitation Specialist
- Glendale, AZ
National Provider Identifier
1669072161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Day Training/Habilitation Specialist
- Practice address
- 6148 W Frier Dr
Glendale, AZ 85301-1223 - Phone
- (315) 955-0170
- NPI assigned
- Oct 26, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Day Training/Habilitation Specialist | 373H00000X | Primary |
Addresses
Primary practice location
6148 W Frier Dr
Glendale, AZ 85301-1223
Mailing address
6148 W Frier Dr
Glendale, AZ 85301-1223
Phone (315) 955-0170
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7777777 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603670400000",
"number": "1669072161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6148 W FRIER DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853011223",
"telephone_number": "315-955-0170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6148 W FRIER DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853011223",
"telephone_number": "315-955-0170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARDOZA",
"first_name": "KELLIE",
"middle_name": "L",
"credential": "BHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-26",
"last_updated": "2020-10-26",
"certification_date": "2020-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "373H00000X",
"taxonomy_group": "",
"desc": "Day Training/Habilitation Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7777777",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.