NPIMap

Organization Active NPI

Mary Group Home LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1760342083
Registry record updated Nov 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
MARY GROUP HOME LLC
Practice address
12643 N 22ND Ave
Phoenix, AZ 85029-2652
Phone
(480) 577-7777
NPI assigned
Nov 18, 2025
Last updated
Nov 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2025

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

Authorized official

Name
Abdalla Elkhalifa
Title
Ceo
Phone
(480) 577-7777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

12643 N 22ND Ave
Phoenix, AZ 85029-2652

Mailing address

12643 N 22ND Ave
Phoenix, AZ 85029-2652
Phone (480) 577-7777

National Provider Directory

National Provider Directory
Tax ID family
Mary Group Home LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1763424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763424000000",
    "number": "1760342083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12643 N 22ND AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850292652",
            "telephone_number": "480-577-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12643 N 22ND AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850292652",
            "telephone_number": "480-577-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-18",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A",
        "authorized_official_last_name": "ELKHALIFA",
        "authorized_official_first_name": "ABDALLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-577-7777"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 18, 2025; 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.