NPIMap

Organization Active NPI

Martha's Residential Care LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Peoria, AZ
National Provider Identifier
1962818187
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH4469 Issued in AZ
Legal business name
MARTHA'S RESIDENTIAL CARE LLC
Practice address
8572 W Palo Verde Ave
Peoria, AZ 85345-5354
Phone
(480) 217-6996
Fax
(480) 452-0243
NPI assigned
Jul 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Authorized official

Name
Saffiatu S Tunis, PHD
Title
Program Director
Phone
(480) 217-6996

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH4469 AZ Primary
Mental Illness Community Based Residential Treatment Facility 320800000X BH4907 AZ
Mental Illness Community Based Residential Treatment Facility 320800000X

Addresses

Primary practice location

8572 W Palo Verde Ave
Peoria, AZ 85345-5354

Mailing address

22958 W Pima St
Buckeye, AZ 85326-8734
Phone (623) 271-8248

Other identifiers 1

IdentifierTypeStateIssuer
BH6971OtherAZLICENSE

National Provider Directory

National Provider Directory
Tax ID family
Martha's Residential Care LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1962818187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22958 W PIMA ST",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853268734",
            "telephone_number": "623-271-8248",
            "fax_number": "480-452-0243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8572 W PALO VERDE AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853455354",
            "telephone_number": "480-217-6996",
            "fax_number": "480-452-0243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTHA'S RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-08",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "TUNIS",
        "authorized_official_first_name": "SAFFIATU",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "480-217-6996",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4469",
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH4907",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "BH6971",
            "state": "AZ"
        }
    ],
    "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 Aug 16, 2021; 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.