NPIMap

Organization Active NPI

Springbrook Habilitation Services, LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1699946533
Registry record updated Dec 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH-2372 Issued in AZ
Legal business name
SPRINGBROOK HABILITATION SERVICES, LLC
Practice address
12002 N 28TH St
Phoenix, AZ 85028-1114
Phone
(602) 795-2088
NPI assigned
Mar 19, 2008
Last updated
Dec 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2009

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

Authorized official

Name
Mr. George W. Green Jr., M.ED.
Title
Clinical Director
Phone
(602) 424-1838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH-2372 AZ Primary

Addresses

Primary practice location

12002 N 28TH St
Phoenix, AZ 85028-1114

Mailing address

4835 E Cactus Rd
Suite 460
Scottsdale, AZ 85254-4191
Phone (602) 424-1838

Other identifiers 1

IdentifierTypeStateIssuer
819013MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Springbrook Habilitation Services LLC4 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.

NPI Registry JSON

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1699946533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 E CACTUS RD",
            "address_2": "SUITE 460",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852544191",
            "telephone_number": "602-424-1838",
            "fax_number": "602-424-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12002 N 28TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850281114",
            "telephone_number": "602-795-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGBROOK HABILITATION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "602-424-1838",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.ED."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH-2372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "819013",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.