NPIMap

Organization Active NPI

Santa Rosa Elderly Center

  • Public Health or Welfare Agency
  • Santa Rosa, AZ
National Provider Identifier
1841379989
Registry record updated May 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
SANTA ROSA ELDERLY CENTER
Practice address
Junction of Bia 15 and Bia 34
Santa Rosa, AZ 85634
Phone
(520) 295-2503
Fax
(520) 295-2676
NPI assigned
Nov 2, 2006
Last updated
May 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2008

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

Authorized official

Name
Priscilla Whitethorne
Title
Service Unit Director
Phone
(520) 383-7251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

Junction of Bia 15 and Bia 34
Santa Rosa, AZ 85634

Mailing address

7900 S J Stock Rd
Tucson, AZ 85746-7012
Phone (520) 295-2503

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050301000125 TX Part B Supplier - Clinic/Group Practice 5092768663 Receives reassigned benefits from 353 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sells, AZ

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1841379989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 S J STOCK RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857467012",
            "telephone_number": "520-295-2503",
            "fax_number": "520-295-2676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "JUNCTION OF BIA 15 AND BIA 34",
            "city": "SANTA ROSA",
            "state": "AZ",
            "postal_code": "85634",
            "telephone_number": "520-295-2503",
            "fax_number": "520-295-2676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA ELDERLY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "WHITETHORNE",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_title_or_position": "SERVICE UNIT DIRECTOR",
        "authorized_official_telephone_number": "520-383-7251"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.