NPIMap

Organization Active NPI

Mikid, Mentally Ill Kids in Distress

  • Voluntary or Charitable Agency
  • Phoenix, AZ
National Provider Identifier
1891701280
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Voluntary or Charitable AgencyTaxonomy code 251V00000X
License
CSA05CP0172 Issued in AZ
Legal business name
MIKID, MENTALLY ILL KIDS IN DISTRESS
Practice address
755 E Willetta St
Ste. 128
Phoenix, AZ 85006-2723
Phone
(602) 253-1240
Fax
(602) 253-1250
NPI assigned
Jul 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Authorized official

Name
Jeff Kazmierczak, RN,MSN,MBA
Title
Executive Director
Phone
(602) 253-1240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Voluntary or Charitable Agency 251V00000X CSA05CP0172 AZ Primary

Addresses

Primary practice location

755 E Willetta St
Ste. 128
Phoenix, AZ 85006-2723

Mailing address

755 E Willetta St
Ste. 128
Phoenix, AZ 85006-2723
Phone (602) 253-1240

Other identifiers 1

IdentifierTypeStateIssuer
895394MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Mentally Ill Kids in Distress12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

775 E Willetta St
Ste 128
Phoenix, AZ 85006
Phone (602) 253-1240

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1891701280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 E WILLETTA ST",
            "address_2": "STE. 128",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062723",
            "telephone_number": "602-253-1240",
            "fax_number": "602-253-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 E WILLETTA ST",
            "address_2": "STE. 128",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062723",
            "telephone_number": "602-253-1240",
            "fax_number": "602-253-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKID, MENTALLY ILL KIDS IN DISTRESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "KAZMIERCZAK",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "602-253-1240",
        "authorized_official_credential": "RN,MSN,MBA"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "AZ",
            "license": "CSA05CP0172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "895394",
            "state": "AZ"
        }
    ],
    "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 Aug 14, 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.