HACIENDA INC NPI 1417178724

NPI Information

NPI: 1417178724
Provider Name: HACIENDA INC
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

CLIA Number: 03D0980237

Address:
1402 E SOUTH MOUNTAIN AVE
PHOENIX, AZ
ZIP 85042
Phone: (602) 243-4231
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HACIENDA INC is an intermediate care facility mentally retarded in Phoenix, AZ. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. HACIENDA INC NPI is 1417178724. The provider is registered as an organization entity type.

The provider's business location address is:

1402 E SOUTH MOUNTAIN AVE
PHOENIX, AZ
ZIP 85042-925
Phone: (602) 243-4231
Fax: (602) 323-5988

The provider's authorized official is Barbara Newport .
The authorized official title is Credentialing/licensing Manager and has the following contact phone number (602) 510-3514.

The CLIA number assigned to this NPI record is 03D0980237 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/2/2007 and was last updated on 11/9/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		LTC0176	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	040064	MEDICAID	ARIZONA
2	ICF001	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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