Graceland Behavioral Home LLC

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

Legal business name

GRACELAND BEHAVIORAL HOME LLC

Practice address

35696 W Santa Monica Ave
Maricopa, AZ 85138-2620

Phone

(602) 752-7158

NPI assigned

Aug 30, 2022

Organization subpart

No

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

Authorized official

Name

Kofi Owusu Kusi

Title

Owner

Phone

(602) 752-7158

Specialties & licenses 1

Addresses

Other names 1

• Graceland Behavioral Home Doing business as

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1811617889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35696 W SANTA MONICA AVE",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851382620",
            "telephone_number": "602-752-7158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35696 W SANTA MONICA AVE",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851382620",
            "telephone_number": "602-752-7158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACELAND BEHAVIORAL HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "KUSI",
        "authorized_official_first_name": "KOFI",
        "authorized_official_middle_name": "OWUSU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-752-7158"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graceland Behavioral Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility (Behavioral Disturbances) in Maricopa, AZ
• Providers in Maricopa, AZ by specialty
• Assisted Living Facility (Behavioral Disturbances) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.