THE FACTS OF LIFE GROUPHOME, INC


Address: 1122 E. Buckeye Road, Phoenix, AZ 85034
Phone: 4805937402

THE FACTS OF LIFE GROUPHOME, INC (NPI# 1386928414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1386928414
Entity Type Organization
Organization Name THE FACTS OF LIFE GROUPHOME, INC
Practice Address 1122 E. Buckeye Road
Phoenix
AZ 85034
Mailing Address 1122 E. Buckeye Road
Suite A4
Phoenix
AZ 85034
Practice Telephone 4805937402
Mailing Telephone 4805937402
Enumeration Date 2011-10-07
Last Update Date 2011-10-07
Authorized Official Name YOLANDA ROBINSON (FOUNDER/CEO)
Authorized Official Telephone 4805937402
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 251S00000X Community/Behavioral Health BH3920 AZ Agencies

Office Location

Street Address 1122 E. BUCKEYE ROAD
City PHOENIX
State AZ
Zip Code 85034

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1568869915 Lacee Johnson Speech-Language Pathologist 5025 E Washington Street, Suite 212, Phoenix, AZ 85034 2014-12-01
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1275885030 Nancy Louise Brewer Nurse Practitioner 3800 E Sky Harbor Blvd Fl T4, Phoenix, AZ 85034 2012-10-03
1649559832 Us Medgroup Pa Clinic/Center 901 East Jefferson St, Phoenix, AZ 85034 2011-08-05
1689979106 Latanya King Counselor 1122 East Buckeye Road, Suite B-1, Phoenix, AZ 85034 2011-01-13
1417143322 Us Medgroup, P.a. Clinic/Center 1818 East Sky Harbor Circle, Suite 150, Phoenix, AZ 85034 2007-09-25
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Taxonomy Information

Taxonomy Code 251S00000X
Grouping Agencies
Classification Community/Behavioral Health

Taxonomy Definition

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition]

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Competitor

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City PHOENIX
Zip Code 85034

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Dataset Information

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.

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