Care One Behavioral Health Group Home LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

CARE ONE BEHAVIORAL HEALTH GROUP HOME LLC

Practice address

15550 W Harvard St Apt 123
Goodyear, AZ 85395-7533

Phone

(702) 957-7817

NPI assigned

Sep 13, 2024

Organization subpart

No

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

Authorized official

Name

Marie Bundu Campbell

Title

Manager

Phone

(702) 957-7817

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1726185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1811723943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15550 W HARVARD ST APT 123",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853957533",
            "telephone_number": "702-957-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15550 W HARVARD ST APT 123",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853957533",
            "telephone_number": "702-957-7817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARE ONE BEHAVIORAL HEALTH GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-13",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "BUNDU",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-957-7817"
    },
    "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": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; 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.