Active NPI
Hacienda Inc
- Intellectual Disabilities Intermediate Care Facility
- Phoenix, AZ
National Provider Identifier
1841513413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual Disabilities Intermediate Care Facility
- Legal business name
- HACIENDA INC
- Practice address
- 1402 E South Mountain Ave
Phoenix, AZ 85042-7925 - Phone
- (602) 243-4231
- Fax
- (602) 323-5988
- NPI assigned
- Mar 10, 2010
- 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
- Perry Petrilli
- Title
- Ceo
- Phone
- (602) 243-4231
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Custodial Care Facility | 311Z00000X | DDH1558 | AZ | |
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | Primary |
Addresses
Primary practice location
1402 E South Mountain Ave
Phoenix, AZ 85042-7925
Mailing address
1402 E South Mountain Ave
Phoenix, AZ 85042-7925
Phone (602) 243-4231
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 040064 | Medicaid | AZ | |
| 075368 | Medicaid | AZ |
Other names 1
- Hacienda HCBS
National Provider Directory
National Provider Directory- Tax ID family
- Hacienda HCBS
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Intellectual Disabilities Intermediate Care Facility
- Phoenix, AZ
- NPI 1417178724
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268179200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1739404800000",
"number": "1841513413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 E SOUTH MOUNTAIN AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850427925",
"telephone_number": "602-243-4231",
"fax_number": "602-323-5988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 E SOUTH MOUNTAIN AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850427925",
"telephone_number": "602-243-4231",
"fax_number": "602-323-5988"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HACIENDA INC",
"organizational_subpart": "NO",
"enumeration_date": "2010-03-10",
"last_updated": "2025-02-13",
"certification_date": "2025-02-13",
"status": "A",
"authorized_official_last_name": "PETRILLI",
"authorized_official_first_name": "PERRY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "602-243-4231"
},
"taxonomies": [
{
"code": "311Z00000X",
"taxonomy_group": "",
"desc": "Custodial Care Facility",
"state": "AZ",
"license": "DDH1558",
"primary": false
},
{
"code": "315P00000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Intellectual Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "040064",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "075368",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Hacienda HCBS",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Hacienda HCBS",
"code": "3",
"type": "Doing Business As"
}
]
}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 Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.