Active NPI
Fredrick David Beaver
- Child Mental Illness Respite Care
- Cochise, AZ
National Provider Identifier
1922282904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Mental Illness Respite Care
- Practice address
- 2750 N. Nino Place
Cochise, AZ 85606 - Phone
- (520) 253-0352
- NPI assigned
- Dec 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | AZ | Primary |
Addresses
Primary practice location
2750 N. Nino Place
Cochise, AZ 85606
Mailing address
PO Box 272
Dragoon, AZ 85609-0272
Phone (520) 253-0352
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200268800000",
"number": "1922282904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 272",
"city": "DRAGOON",
"state": "AZ",
"postal_code": "856090272",
"telephone_number": "520-253-0352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2750 N. NINO PLACE",
"city": "COCHISE",
"state": "AZ",
"postal_code": "85606",
"telephone_number": "520-253-0352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAVER",
"first_name": "FREDRICK",
"middle_name": "DAVID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-26",
"last_updated": "2008-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cochise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.