National Mentor Healthcare, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

NATIONAL MENTOR HEALTHCARE, LLC

Doing business as

Arizona Mentor

Practice address

9007 W Deanna Dr
Peoria, AZ 85382-2418

Phone

(602) 200-9494

Fax

(602) 567-2062

NPI assigned

Nov 11, 2014

Last updated

Nov 11, 2014By the provider in NPPES

Organization subpart

Yes

Parent organization

NATIONAL MENTOR HEALTHCARE, LLCAs reported in NPPES

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

Authorized official

Name

Marianna Moore

Title

Regional Director

Phone

(602) 567-4919

Specialties & licenses 1

Addresses

Other names 1

• Arizona Mentor Doing business as

Tax ID family

Arizona Mentor2 organizations share this tax ID, including this one

Part of

California Mentor

Other organizations with this tax ID 1

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

• Institute for Family Centered Services

  • Early Intervention Provider Agency
  • Winston Salem, NC
  • NPI 1003236050
  NPD tax ID

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

{
    "created_epoch": "1415664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415664000000",
    "number": "1710383252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 N 3RD ST",
            "address_2": "SUITE 4000",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041129",
            "telephone_number": "602-200-9494",
            "fax_number": "602-567-2062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9007 W DEANNA DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822418",
            "telephone_number": "602-200-9494",
            "fax_number": "602-567-2062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL MENTOR HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NATIONAL MENTOR HEALTHCARE, LLC",
        "enumeration_date": "2014-11-11",
        "last_updated": "2014-11-11",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MARIANNA",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "602-567-4919"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona Mentor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2014; 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.