HACIENDA INC NPI 1841513413

NPI Information

NPI: 1841513413
Provider Name: HACIENDA INC
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
:
Address: 1402 E SOUTH MOUNTAIN AVE
PHOENIX, AZ
ZIP 85042
Phone: (602) 243-4231

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NPI Details

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 1841513413. The provider is registered as an organization entity type.
The provider .

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 Perry Petrilli .
The authorized official title is Ceo and has the following contact phone number (602) 243-4231.

The enumeration date for this NPI number is 3/10/2010 and was last updated on 2/13/2025.

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	311Z00000X	Custodial Care Facility		DDH1558	ARIZONA	No
2	315P00000X	Intermediate Care Facility, Intellectual Disabilities				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	075368	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: 11/21/2025

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