NPIMap

Organization Active NPI

Loloma House LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Peoria, AZ
National Provider Identifier
1942743711
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH4687 Issued in AZ
Legal business name
LOLOMA HOUSE LLC
Practice address
15259 N 67TH Dr
Peoria, AZ 85381-4502
Phone
(623) 418-6657
Fax
(623) 322-8664
NPI assigned
Nov 29, 2016
Last updated
Nov 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
Mrs. Laura HornbackNPI 1093188138
Title
Owner/Administrative Officer
Phone
(623) 418-6657

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH4687 AZ Primary

Addresses

Primary practice location

15259 N 67TH Dr
Peoria, AZ 85381-4502

Mailing address

15259 N 67TH Dr
Peoria, AZ 85381-4502
Phone (623) 418-6657

National Provider Directory

National Provider Directory
Tax ID family
Loloma House LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1480377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1942743711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15259 N 67TH DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814502",
            "telephone_number": "623-418-6657",
            "fax_number": "623-322-8664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15259 N 67TH DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814502",
            "telephone_number": "623-418-6657",
            "fax_number": "623-322-8664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOLOMA HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-29",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "HORNBACK",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "623-418-6657",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.