NPIMap

Organization Active NPI

South Mountain Holistic Care

  • Mental Illness Intermediate Care Facility
  • Laveen, AZ
National Provider Identifier
1770038564
Registry record updated Aug 22, 2016
On this page

Key facts

NPPES NPI Registry
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
Last updated
Aug 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2016

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

Authorized official

Name
Ms. Stephanie Lynn BrighamNPI 1700253994
Title
Executive Director
Phone
(602) 565-5909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X BH4914 AZ Primary

Addresses

Primary practice location

3219 W Olney Ave
Laveen, AZ 85339-1783

Mailing address

3219 W Olney Ave
Laveen, AZ 85339
Phone (602) 565-5909

National Provider Directory

National Provider Directory

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.

NPI Registry JSON

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": []
}

Other providers in Laveen, AZ

Sources for this page

  • 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.