MARY'S MISSION & DEVELOPMENTAL CENTER, INC. (NPI# 1336250190) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336250190 |
| Entity Type | Organization |
| Organization Name | MARY'S MISSION & DEVELOPMENTAL CENTER, INC. |
| Practice Address |
8360 S Highway 92 Hereford AZ 85615-9087 |
| Mailing Address |
345 Taylor Dr Sierra Vista AZ 85635-3801 |
| Practice Telephone | 5203785175 |
| Practice Fax Number | 5204593642 |
| Mailing Telephone | 5204172115 |
| Mailing Fax Number | 5204172114 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. WILLIAM LACEY (CEO/ADMINISTRATOR) |
| Authorized Official Telephone | 5204172115 |
| Authorized Official Credential | M.B.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | BH-2206 | AZ | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912209859 | Mary's Mission & Developmental Center, Inc. | Community/Behavioral Health | 736 N Country Club Dr, Mesa, AZ 85201-4936 | 2010-11-29 |
| Street Address |
8360 S HIGHWAY 92 |
| City | HEREFORD |
| State | AZ |
| Zip Code | 85615-9087 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447763677 | Diana Deray Jones | Registered Nurse | Palominas Elementary School, 6849 E. Hwy 92, Hereford, AZ 85615 | 2017-11-09 |
| 1558751800 | Goldenoaks | Assisted Living Facility | 8099 Geoffrion St, Hereford, AZ 85615 | 2015-01-26 |
| 1649536251 | Joel Childs | Respite Care | 9367 Chippewa Drive, Hereford, AZ 85615 | 2012-04-09 |
| 1275835167 | Anne M Castello | Behavioral Analyst | 9345 S. Reynolds Rd., Hereford, AZ 85615 | 2010-11-26 |
| 1609916774 | Evelyn Becker | Psychologist | 10385 E. Highway 92, Hereford, AZ 85615 | 2007-02-07 |
| 1568539625 | Steven Richard Germann | Respite Care | 10056 S. Corgi Lane, Hereford, AZ 85615 | 2006-11-30 |
| 1477620532 | Kathleen Christine Valencia | Respite Care | 10330 S. Palominas Road, Hereford, AZ 85615 | 2006-11-30 |
| 1629417431 | Julie Marie Hutchinson | Nurse Practitioner | 10524 E Highway 92, Hereford, AZ 85615 | 2013-06-14 |
| 1942485040 | Leisa Diane Wilson Boyer | Contractor | 10385 E Hwy 92, Palominas School Dist, Hereford, AZ 85615 | 2008-01-08 |
| 1952426769 | Sandra West | Registered Nurse | 10385 E Hwy 92, Hereford, AZ 85615 | 2007-03-20 |
| Find all providers in zip 85615 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215038757 | Alta Vista Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 4108 E Ramsey Rd, Hereford, AZ 85615-8917 | 2006-09-26 |
| 1447357728 | Vista Care LLC | Residential Treatment Facility, Emotionally Disturbed Children | 4120 E Ramsey Rd, Hereford, AZ 85615-8917 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528666039 | Rehoboth LLC | Residential Treatment Facility, Emotionally Disturbed Children | 46136 W Mountain View Rd # A, Maricopa, AZ 85139-6796 | 2020-10-16 |
| 1962022665 | New Hope of Arizona, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8710 W Watkins St, Tolleson, AZ 85353-9028 | 2020-04-22 |
| 1639798143 | Anthony Udoinwang | Residential Treatment Facility, Emotionally Disturbed Children | 10435 W Reade Ave, Glendale, AZ 85307-4237 | 2020-04-14 |
| 1033756358 | Native Music Coalition | Residential Treatment Facility, Emotionally Disturbed Children | 5150 S Crazy Cat Ln, Tucson, AZ 85735 | 2019-12-05 |
| 1013558311 | Back To Life Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 6420 W Cocopah St, Phoenix, AZ 85043 | 2019-10-08 |
| 1487118865 | Serenity Preferred LLC | Residential Treatment Facility, Emotionally Disturbed Children | 17829 W Columbine Dr, Surprise, AZ 85388-5628 | 2019-01-30 |
| 1407333958 | Copa's Caring Hands LLC. | Residential Treatment Facility, Emotionally Disturbed Children | 42251 W Bravo Dr, Maricopa, AZ 85138-2295 | 2018-07-26 |
| 1538668983 | Starks Homes LLC | Residential Treatment Facility, Emotionally Disturbed Children | 7325 E Fayette St, Tucson, AZ 85730-2324 | 2018-02-12 |
| 1881100147 | Anna Marie Barrios | Residential Treatment Facility, Emotionally Disturbed Children | 18811 N 7th Dr, Phoenix, AZ 85027-5508 | 2017-12-22 |
| 1033625926 | Youth Transition Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1190 S Boulder St Unit D, Gilbert, AZ 85296-3792 | 2017-12-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.