San Judas Group Home

LBN: San Judas Group Home
San Judas Group Home is an health care organization with primary practice located at 5116 S 11Th Ave , Phoenix AZ 85041-2363. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Physical Disabilities, which is considered as the primary health care specialty. San Judas Group Home can be contacted via phone (602) 643-5932, or through Noriega, Imelda Melissa via phone (602) 643-5932.

Contact Information

Primary practice address
5116 S 11Th Ave Phoenix AZ 85041-2363
Phone: (602) 643-5932
Fax: (602) 281-6974
Website:
Map and Directions
Authorized official contact:
Name: Noriega, Imelda Melissa
Phone: (602) 643-5932

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Physical Disabilities 320700000X ALH6076 Arizona

Profile Details

NPI number 1386969947
LBN Legal business name San Judas Group Home
DBA Doing business as
Authorized official Noriega, Imelda Melissa
Entity Organization
Organization subpart 1 No
Enumeration date Apr 7th, 2010
Last updated Apr 7th, 2010 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386969947 NPPES
Arizona MEDICAID 203799

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