NPIMap

Organization Active NPI

Eureka Imperial Residence

  • Mental Illness Community Based Residential Treatment Facility
  • Gilbert, AZ
National Provider Identifier
1679704381
Registry record updated Jul 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH3319 Issued in AZ
Legal business name
EUREKA IMPERIAL RESIDENCE
Practice address
1740 S Heritage Drive
Gilbert, AZ 85296
Phone
(480) 264-2647
Fax
(480) 264-2647
NPI assigned
Jul 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2009

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

Authorized official

Name
Mr. Cornelius Ebai Tanyi
Title
Executive Director
Phone
(480) 375-5192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH3319 AZ Primary

Addresses

Primary practice location

1740 S Heritage Drive
Gilbert, AZ 85296

Mailing address

7110 S Champagne Way
Gilbert, AZ 85298-9122
Phone (480) 375-5192

National Provider Directory

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

Other organizations with this tax ID 3

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

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248825600000",
    "number": "1679704381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7110 S CHAMPAGNE WAY",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852989122",
            "telephone_number": "480-375-5192",
            "fax_number": "480-821-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 S HERITAGE DRIVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85296",
            "telephone_number": "480-264-2647",
            "fax_number": "480-264-2647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUREKA IMPERIAL RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-29",
        "last_updated": "2009-07-29",
        "status": "A",
        "authorized_official_last_name": "TANYI",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_middle_name": "EBAI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "480-375-5192",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH3319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 29, 2009; 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.