NPIMap

Organization Active NPI

Legacy Senior Management LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Mesa, AZ
National Provider Identifier
1780177535
Registry record updated Jun 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH5449 Issued in AZ
Legal business name
LEGACY SENIOR MANAGEMENT LLC
Practice address
152 N 56TH St Ste B
Mesa, AZ 85205-8718
Phone
(480) 985-0680
Fax
(480) 396-6231
NPI assigned
Jun 7, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2018

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

Authorized official

Name
Mary Grace Leach
Title
Coe
Phone
(602) 368-8203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH5449 AZ Primary

Addresses

Primary practice location

152 N 56TH St Ste B
Mesa, AZ 85205-8718

Mailing address

3602 E Greenway Rd Ste 104
Phoenix, AZ 85032-4648
Phone (602) 368-8203

Other identifiers 1

IdentifierTypeStateIssuer
BH5449OtherAZARIZONA DEPARTMENT OF HEALTH SERVICES

Other names 1

  • Copper Heights BH Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Copper Heights4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1528329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528329600000",
    "number": "1780177535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3602 E GREENWAY RD STE 104",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850324648",
            "telephone_number": "602-368-8203",
            "fax_number": "602-368-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 N 56TH ST STE B",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852058718",
            "telephone_number": "480-985-0680",
            "fax_number": "480-396-6231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY SENIOR MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-07",
        "last_updated": "2018-06-07",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "COE",
        "authorized_official_telephone_number": "602-368-8203"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH5449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA DEPARTMENT OF HEALTH SERVICES",
            "identifier": "BH5449",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copper Heights BH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Copper Heights BH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; 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.