HACIENDA INC (NPI# 1417178724) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417178724 |
| Entity Type | Organization |
| Organization Name | HACIENDA INC |
| Practice Address |
1402 E South Mountain Ave Phoenix AZ 85042-7925 |
| Practice Telephone | 6022434231 |
| Practice Fax Number | 6023235988 |
| Mailing Telephone | 6022434231 |
| Mailing Fax Number | 6023235988 |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-11-09 |
| Authorized Official Name | BARBARA NEWPORT (CREDENTIALING/LICENSING MANAGER) |
| Authorized Official Telephone | 6025103514 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | LTC0176 | AZ | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 040064 | 05 | |
| AZ | ICF001 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841513413 | Hacienda Inc | Custodial Care Facility | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2010-03-10 |
| Street Address |
1402 E SOUTH MOUNTAIN AVE |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85042-7925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710976956 | Hacienda Skilled Nursing Facility, Inc. | Skilled Nursing Facility | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2005-10-20 |
| 1568909422 | Emily Miller | Occupational Therapist | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2017-01-30 |
| 1841513413 | Hacienda Inc | Custodial Care Facility | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2010-03-10 |
| 1306169404 | Kate Moore | Speech-Language Pathologist | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2010-03-04 |
| 1558693937 | Los Ninos Hospital, Inc | Non-emergency Medical Transport (VAN) | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2010-02-09 |
| 1831322676 | Hacienda Skilled Nursing Facility | Skilled Nursing Facility | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2009-08-27 |
| 1962677674 | Dale Heinz | Occupational Therapist | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2008-04-23 |
| 1093986291 | Viviana Montalvan | Occupational Therapist | 1402 E South Mountain Ave, Rehab Dept, Phoenix, AZ 85042-7925 | 2008-03-14 |
| 1326262395 | Los Ninos Hospital, Inc. | Clinic/Center | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2007-04-12 |
| 1518001783 | Miriam Alfaro | Physical Therapist | 1402 E South Mountain Ave, Phoenix, AZ 85042-7925 | 2007-02-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306443197 | Da Homes LLC | Case Management | 8026 S. 24th Way, Phoenix, AZ 85042 | 2020-10-05 |
| 1144790460 | Ebony House Inc | Substance Abuse Rehabilitation Facility | 6222 S. 13th Street, Phoenix, AZ 85042 | 2018-11-29 |
| 1427538362 | Abigail Mcgrath | Dietitian, Registered | 303 E Baseline Rd Ste 200, Phoenix, AZ 85042 | 2018-08-20 |
| 1174028310 | Olufemi A Omodara | Pharmacist | 7227 S. Central Ave, #1080, Phoenix, AZ 85042 | 2018-03-29 |
| 1720537699 | Mary Youngblood | Registered Nurse | 7210 S 27th Way, Phoenix, AZ 85042 | 2016-10-03 |
| 1922490382 | Brian Zembower | Optometrist | 610 E Baseline Rd Ste C3, Phoenix, AZ 85042 | 2015-02-23 |
| 1417299819 | Robert Murphy Portley | Psychiatry & Neurology | 2320 E Baseline Rd Ste 148-225, Phoenix, AZ 85042 | 2013-03-23 |
| 1972807998 | Obinna Chukwuka Akubukwe | Pharmacist | 6006 S. Central Avenue, Phoenix, AZ 85042 | 2011-01-05 |
| 1104120328 | Gisheys Patient Care LLC | Custodial Care Facility | 7232 South 12th Place, Phoeniz, AZ 85042 | 2011-01-03 |
| 1245463488 | Lois Ann Hammitt | Registered Nurse | 6218 S. 7th Street, Phoenix, AZ 85042 | 2009-09-03 |
| Find all providers in zip 85042 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881859536 | Arizona Training Program - Windsor | Intermediate Care Facility, Mentally Retarded | 1750 E Windsor, Phoenix, AZ 85006 | 2008-07-22 |
| 1619132354 | Arizona Training Program - Pinchot | Intermediate Care Facility, Mentally Retarded | 3322 E Pinchot, Phoenix, AZ 85018 | 2008-07-22 |
| 1982869632 | Arizona Training Program - Campbell | Intermediate Care Facility, Mentally Retarded | 2327 W Campbell, Phoenix, AZ 85015 | 2008-07-22 |
| 1306001052 | Arizona Training Program - Earll | Intermediate Care Facility, Mentally Retarded | 3043 N 37th Street, Phoenix, AZ 85018 | 2008-07-22 |
| 1528423589 | Rescare Arizona, Inc. | Intermediate Care Facility, Mentally Retarded | 960 W Behrend Dr Ste 3, Phoenix, AZ 85027-4406 | 2015-12-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679103196 | Better Horizons LLC | Intermediate Care Facility, Mentally Retarded | 18491 E Ashridge Dr, Queen Creek, AZ 85142-3619 | 2020-01-23 |
| 1073978037 | Rescare Arizona, Inc. | Intermediate Care Facility, Mentally Retarded | 6633 E Mary Dr, Tucson, AZ 85730-1650 | 2015-12-17 |
| 1336513043 | Rescare Arizona, Inc. | Intermediate Care Facility, Mentally Retarded | 413 E Rodeo Dr, Tucson, AZ 85714-2842 | 2015-11-18 |
| 1992179600 | Rescare Arizona, Inc. | Intermediate Care Facility, Mentally Retarded | 6624 E 39th St, Tucson, AZ 85730-1612 | 2015-11-18 |
| 1457725160 | Rescare Arizona, Inc. | Intermediate Care Facility, Mentally Retarded | 1070 W Schafer Dr, Tucson, AZ 85705-1528 | 2015-11-18 |
| 1093189706 | Rescare Arizona, Inc. | Intermediate Care Facility, Mentally Retarded | 140 S Camino Seco, Suite 305, Tucson, AZ 85710-4484 | 2015-11-18 |
| 1710130059 | Arizona Training Program @coolidge | Intermediate Care Facility, Mentally Retarded | 2800 N. Highway 87, Coolidge, AZ 85228 | 2008-10-30 |
| 1639323082 | Arizona Training Program @ Coolidge | Intermediate Care Facility, Mentally Retarded | 2800 N. Highway 87, Coolidge, AZ 85228 | 2008-11-12 |
| 1528212974 | Arizona Training Program @ Coolidge | Intermediate Care Facility, Mentally Retarded | 2800 N. Highway 87, Coolidge, AZ 85228 | 2008-11-12 |
| 1992959340 | Arizona Training Program @ Coolidge | Intermediate Care Facility, Mentally Retarded | 2800 N. Highway 87, Coolidge, AZ 85228 | 2008-11-12 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on HACIENDA INC.
| 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.