EASTER SEALS BLAKE FOUNDATION (NPI# 1528400538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528400538 |
| Entity Type | Organization |
| Organization Name | EASTER SEALS BLAKE FOUNDATION |
| Other Organization Name | BLAKE FOUNDATION |
| Practice Address |
1115 E Florence Blvd Suite A Casa Grande AZ 85122-4228 |
| Mailing Address |
6420 E Broadway Blvd Suite B-200 Tucson AZ 85710-3534 |
| Practice Telephone | 5207234429 |
| Mailing Telephone | 5202077310 |
| Mailing Fax Number | 5207954981 |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2013-07-19 |
| Authorized Official Name | EMA KAMMEYER (CEO) |
| Authorized Official Telephone | 5203271520 |
| Authorized Official Credential | JD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | BH-4277 | AZ | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | ARIZONA DEPARTMENT OF HEALTH SERVICES - OFFICE OF BEHAVIORAL HEA | BH-4227 | 01 |
| Other Name | Type Code |
|---|---|
| Blake Foundation | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053828160 | Easter Seals Blake Foundation | Community/Behavioral Health | 618 South Central Avenue, Safford, AZ 85546 | 2018-01-10 |
| 1548781487 | Easter Seals Blake Foundation | Community/Behavioral Health | 7750 E Broadway Blvd Ste A100, Tucson, AZ 85710-3901 | 2017-06-30 |
| 1376967323 | Easter Seals Blake Foundation | Community/Behavioral Health | 1060 S 5th Ave, Yuma, AZ 85364-3823 | 2014-02-11 |
| 1932530797 | Easter Seals Blake Foundation | Community/Behavioral Health | 7756 E Broadway Blvd, Ste. A-100, Tucson, AZ 85710 | 2013-12-04 |
| 1679847834 | Easter Seals Blake Foundation | Community/Behavioral Health | 320 S Convent Ave, Tucson, AZ 85701-2215 | 2012-03-05 |
| 1104079714 | Easter Seals Blake Foundation | Community/Behavioral Health | 1938 W Thatcher Blvd, Safford, AZ 85546-3318 | 2008-10-28 |
| 1548356207 | Easter Seals Blake Foundation | Case Management | 5704 E. Grant Road, Tucson, AZ 85712 | 2006-10-04 |
| 1760906440 | Easter Seals Blake Foundation | Counselor | 310 S Meyer Ave, Tucson, AZ 85701-2207 | 2017-08-03 |
| 1164875969 | Easter Seals Blake Foundation | Clinic/Center | 288 N Ironwood Dr Ste 115, Apache Junction, AZ 85120-3830 | 2016-07-15 |
| 1194156125 | Easter Seals Blake Foundation | Residential Treatment Facility, Emotionally Disturbed Children | 5626 E 2nd St, Tucson, AZ 85711-1415 | 2013-12-02 |
| Street Address |
1115 E FLORENCE BLVD SUITE A |
| City | CASA GRANDE |
| State | AZ |
| Zip Code | 85122-4228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407006380 | Jennifer L Enders | Counselor | 1115 E Florence Blvd, Casa Grande, AZ 85122-4228 | 2008-09-26 |
| 1740734458 | Veronica Agredano Ellis | Social Worker | 1115 E Florence Blvd, Casa Grande, AZ 85122-4228 | 2016-08-10 |
| 1659825453 | Lauren Shavers | Marriage & Family Therapist | 1115 E Florence Blvd, Suite A, Casa Grande, AZ 85122-4228 | 2016-08-09 |
| 1801247887 | Ashia Deshund Taylor | Counselor | 1115 E Florence Blvd, Casa Grande, AZ 85122-4228 | 2016-06-30 |
| 1710337670 | Leroyce Smith | Social Worker | 1115 E Florence Blvd, Suite A, Casa Grande, AZ 85122-4228 | 2016-06-21 |
| 1033567706 | Melissa Ann Montgomery | Social Worker | 1115 E Florence Blvd, Suite A, Casa Grande, AZ 85122-4228 | 2016-06-02 |
| 1215385984 | Lindsey Rhett | Marriage & Family Therapist | 1115 E Florence Blvd, Ste A, Casa Grande, AZ 85122-4228 | 2016-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043857097 | Karen M Garcia | Registered Nurse | 2631 N Brown Avenue, Casa Grande, AZ 85122 | 2019-12-09 |
| 1063060291 | Martha Bollin | Registered Nurse | 2631 N. Brown Ave., Casa Grande, AZ 85122 | 2019-08-30 |
| 1841846920 | Banner Imaging Services LLC | Radiology | 1828 E. Florence Blvd Bldg B Ste 118 & 128, Suite 118 and 128, Casa Grande, AZ 85122 | 2019-08-14 |
| 1629532692 | Kirk Lee Mackley | Physical Therapist | Vibrant Care, 1355 E Florence Blvd #137, Casa Grande, AZ 85122 | 2019-01-24 |
| 1205307436 | Natalie T Trujillo | Physician Assistant | 301 E Cottonwood Ln Ste 1&2, Casa Grande, AZ 85122 | 2018-12-16 |
| 1710455860 | Community Intervention Associates, Inc | Clinic/Center | 1667 N. Trekell Rd, Suite 101 & 102, Casa Grande, AZ 85122 | 2018-11-07 |
| 1245728302 | Jenkins Chiropractic LLC | Chiropractor | 1891 N Trekell Rd Ste 2, Casa Grande, AZ 85122 | 2018-04-24 |
| 1497242408 | Kelly Winnett | Naturopath | 1415 N Trekell Rd Ste 102, Casa Grande, AZ 85122 | 2018-04-16 |
| 1851895783 | Michael Brubaker Counseling | Community/Behavioral Health | 1927 N. Trekell Rd, Ste D, Casa Grande, AZ 85122 | 2018-03-23 |
| 1770095317 | Walmart Stores Inc. | Pharmacy | 1741 E. Florence Blvd, Casa Grande, AZ 85122 | 2017-11-03 |
| Find all providers in zip 85122 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851895783 | Michael Brubaker Counseling | Community/Behavioral Health | 1927 N. Trekell Rd, Ste D, Casa Grande, AZ 85122 | 2018-03-23 |
| 1962915892 | Crisis Preparation and Recovery, Inc | Community/Behavioral Health | 1828 E Florence Blvd Ste 143, Casa Grande, AZ 85122-4783 | 2017-11-14 |
| 1003327594 | Intermountain Health Center, Inc. | Community/Behavioral Health | 1821 N. Trekell Road, Suite 1, Casa Grande, AZ 85122 | 2017-10-24 |
| 1730620634 | Community Provider of Enrichment Services Inc | Community/Behavioral Health | 609 W Cottonwood Ln Ste 4, Casa Grande, AZ 85122-2248 | 2017-03-13 |
| 1659827707 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | 1821 N Trekell Rd Ste 1, Casa Grande, AZ 85122-1705 | 2016-08-29 |
| 1104285964 | Grossman & Grossman Ltd | Community/Behavioral Health | 125 N Florence St, Casa Grande, AZ 85122-4418 | 2016-02-22 |
| 1831557818 | Grossman & Grossman Ltd | Community/Behavioral Health | 123 N Florence St, Casa Grande, AZ 85122-4418 | 2016-02-04 |
| 1114315470 | Rna Property, LLC | Community/Behavioral Health | 117 E 2nd St # 2, Casa Grande, AZ 85122-5477 | 2015-01-08 |
| 1639567209 | Community Intervention Associates | Community/Behavioral Health | 1923 North Trekell Road, Casa Grande, AZ 85122 | 2015-01-05 |
| 1407257595 | Mikid Mentally Ill Kids In Distress | Community/Behavioral Health | 901 E Cottonwood Ln Ste Ab, Casa Grande, AZ 85122-2221 | 2014-09-09 |
| Find all providers in CASA GRANDE | ||||
| City | CASA GRANDE |
| Zip Code | 85122 |
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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.