South Mountain Holistic Care

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

License

BH4914 Issued in AZ

Legal business name

SOUTH MOUNTAIN HOLISTIC CARE

Practice address

3219 W Olney Ave
Laveen, AZ 85339-1783

Phone

(602) 565-5909

NPI assigned

Aug 22, 2016

Organization subpart

No

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

Authorized official

Name

Ms. Stephanie Lynn Brigham

Title

Executive Director

Phone

(602) 565-5909

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471824000000",
    "number": "1770038564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3219 W OLNEY AVE",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "85339",
            "telephone_number": "602-565-5909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3219 W OLNEY AVE",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853391783",
            "telephone_number": "602-565-5909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN HOLISTIC CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-22",
        "last_updated": "2016-08-22",
        "status": "A",
        "authorized_official_last_name": "BRIGHAM",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "602-565-5909",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Intermediate Care Facility in Laveen, AZ
• Providers in Laveen, AZ by specialty
• Mental Illness Intermediate Care Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2016; 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.