Desert Agave Homes LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

DESERT AGAVE HOMES LLC

Practice address

810 S 124TH Ave
Avondale, AZ 85323-8490

Phone

(623) 242-7962

NPI assigned

Feb 3, 2021

Last updated

Feb 3, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Madison Shaun BrownNPI 1376148544

Title

Owner

Phone

(646) 460-1913

Specialties & licenses 1

Addresses

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.

• Madison Shaun Brown

  • Community/Behavioral Health Agency
  • Avondale, AZ
  • NPI 1376148544
  NPD Authorized official

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1780275537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3403 E DIAMOND AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852044017",
            "telephone_number": "646-460-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 S 124TH AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853238490",
            "telephone_number": "623-242-7962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT AGAVE HOMES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MADISON",
        "authorized_official_middle_name": "SHAUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-460-1913"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joe Delgado Jr
• Alyssa Delgado
• Bridgett Deltoro
• Denova Collaborative Health, LLC
• Dental and Braces Dysart LLC
• Desert Lake Family Dentistry Inc
• Desert Life Center LLC
• Desert Life Center LLC
• Desert Rain Health and Wellbeing
• Desert Rose Medical Consultants,P.C.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.