Active NPI
Prime Care Residential and Behavioral Services
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Phoenix, AZ
National Provider Identifier
1801744065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Legal business name
- PRIME CARE RESIDENTIAL AND BEHAVIORAL SERVICES
- Practice address
- 6565 N 17TH Ave Apt 11
Phoenix, AZ 85015-1330 - Phone
- (801) 815-3521
- NPI assigned
- Mar 21, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Matilda Namuchana Masumba
- Title
- Authorized Official
- Phone
- (801) 815-3521
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Primary |
Addresses
Primary practice location
6565 N 17TH Ave Apt 11
Phoenix, AZ 85015-1330
Mailing address
6565 N 17TH Ave Apt 11
Phoenix, AZ 85015-1330
Phone (801) 815-3521
National Provider Directory
National Provider Directory- Tax ID family
- Prime Care Residential and Behavioral Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Phoenix, AZ
- NPI 1780523175
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1774051200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788393600000",
"number": "1801744065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6565 N 17TH AVE APT 11",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850151330",
"telephone_number": "801-815-3521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6565 N 17TH AVE APT 11",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850151330",
"telephone_number": "801-815-3521"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRIME CARE RESIDENTIAL AND BEHAVIORAL SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2026-03-21",
"last_updated": "2026-09-03",
"certification_date": "2026-09-03",
"status": "A",
"authorized_official_last_name": "MASUMBA",
"authorized_official_first_name": "MATILDA",
"authorized_official_middle_name": "NAMUCHANA",
"authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "801-815-3521"
},
"taxonomies": [
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.