NPIMap

Organization Active NPI

Gila River Health Care Corporation

Doing business as Gila River Dialysis West

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Laveen, AZ
National Provider Identifier
1700867819
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
GILA RIVER HEALTH CARE CORPORATION
Doing business as
Gila River Dialysis West
Practice address
9721 W. Pecos Road
Laveen, AZ 85339
Phone
(520) 550-6050
Fax
(520) 550-6051
NPI assigned
Nov 7, 2005
Last updated
Jun 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Mary Judith Roth
Title
Cfo
Phone
(602) 528-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

9721 W. Pecos Road
Laveen, AZ 85339

Mailing address

PO Box 2176
Sacaton, AZ 85247-2176
Phone (602) 271-7901

Other names 1

  • GILA RIVER DIALYSIS WEST Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040721001449 AZ Part A Provider - End-Stage Renal Disease Facility (ESRD) 0648174185 Practice locations: Laveen, AZ

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
033503 Gila River Dialysis WestCCN 033503
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Aug 24, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
20

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1045363Gila River Dialysis West9721 W Pecos Rd, Laveen, AZ 85339Certificate of waiverAug 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Huhukam Memorial Hospit23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Caring HouseSacaton, AZ, CCN 035216 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Direct Ownership Interest (100%)		 Aug 5, 2015
Aug 5, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • The Caring House
    • Skilled Nursing Facility
    • Sacaton, AZ
    • NPI 1912909391

    5% Or Greater Direct Ownership Interest, Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1700867819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2176",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "852472176",
            "telephone_number": "602-271-7901",
            "fax_number": "602-271-7970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9721 W. PECOS ROAD",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "85339",
            "telephone_number": "520-550-6050",
            "fax_number": "520-550-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILA RIVER HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JUDITH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "602-528-1200"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GILA RIVER DIALYSIS WEST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laveen, AZ

Sources for this page

Verify at the official NPI Registry.