Active NPI
Annetta Hardin
- Child Mental Illness Respite Care
- Glendale, AZ
National Provider Identifier
1699841379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Mental Illness Respite Care
- License
- 11688
- Practice address
- 4615 W Lawrence LN
Glendale, AZ 85302-5229 - Phone
- (623) 334-5203
- NPI assigned
- Nov 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | 11688 | AZ | Primary |
Addresses
Primary practice location
4615 W Lawrence LN
Glendale, AZ 85302-5229
Mailing address
4615 W Lawrence LN
Glendale, AZ 85302-5229
Phone (623) 334-5203
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 132419 | Other | AZ | AHCCCS ID NUMBER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11688 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234224000000",
"number": "1699841379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4615 W LAWRENCE LN",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853025229",
"telephone_number": "623-334-5203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4615 W LAWRENCE LN",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853025229",
"telephone_number": "623-334-5203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARDIN",
"first_name": "ANNETTA",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-27",
"last_updated": "2009-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": "11688",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS ID NUMBER",
"identifier": "132419",
"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 Feb 10, 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.