NPIMap

Organization Active NPI

El Mirage Group Home

  • Assisted Living Facility
  • El Mirage, AZ
National Provider Identifier
1801099692
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
ALH-5221 Issued in AZ
Legal business name
EL MIRAGE GROUP HOME
Practice address
13045 W Port Royale LN
El Mirage, AZ 85335-3428
Phone
(602) 367-6491
Fax
(623) 582-8178
NPI assigned
Jun 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Daniela O Micula
Title
Manager
Phone
(602) 367-6491

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X ALH-5221 AZ Primary

Addresses

Primary practice location

13045 W Port Royale LN
El Mirage, AZ 85335-3428

Mailing address

13045 W Port Royale LN
El Mirage, AZ 85335-3428
Phone (602) 367-6491

National Provider Directory

National Provider Directory
Tax ID family
Care First Group Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1181260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801099692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13045 W PORT ROYALE LN",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853353428",
            "telephone_number": "602-367-6491",
            "fax_number": "623-582-8178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13045 W PORT ROYALE LN",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853353428",
            "telephone_number": "602-367-6491",
            "fax_number": "623-582-8178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL MIRAGE GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MICULA",
        "authorized_official_first_name": "DANIELA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "602-367-6491"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "ALH-5221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Mirage, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.