CTB AZ, LLC (NPI# 1770195612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770195612 |
| Entity Type | Organization |
| Organization Name | CTB AZ, LLC |
| Practice Address |
2075 S Cottonwood Dr Tempe AZ 85282-3040 |
| Mailing Address |
2401 W Southern Ave Lot 462 Tempe AZ 85282-4342 |
| Practice Telephone | 6023182041 |
| Mailing Telephone | 6023182041 |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2020-08-21 |
| Authorized Official Name | KELLY MASENGALE (OWNER) |
| Authorized Official Telephone | 6023182041 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| N | 251C00000X | Day Training, Developmentally Disabled Services | Agencies | ||
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| N | 373H00000X | Day Training/Habilitation Specialist | Nursing Service Related Providers | ||
| N | 385HR2060X |
Respite Care Specialization: Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
Respite Care Facility | ||
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| Street Address |
2075 S COTTONWOOD DR |
| City | TEMPE |
| State | AZ |
| Zip Code | 85282-3040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124058466 | Linda S Macconnell | Physician Assistant | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2006-07-03 |
| 1487265278 | Derrick Kai-hung Tang | Psychiatry & Neurology | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2020-08-14 |
| 1730748435 | Next Gen Medicus | Psychologist | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2019-06-07 |
| 1851950521 | Mohamed Khalil | Psychologist | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2019-06-06 |
| 1285106872 | Roxanna Donan | Nurse Practitioner | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2018-12-20 |
| 1568938280 | Shane Doty | Physician Assistant | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2018-10-19 |
| 1154897494 | Ashley Meghan Wanzer | Physician Assistant | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2018-10-14 |
| 1760962823 | Casandra Ray Hamlin | Nurse Practitioner | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2018-08-17 |
| 1972007300 | Tasha Marie Wood | Nurse Practitioner | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2018-03-20 |
| 1679090047 | Elise Carrington Terry | Physician Assistant | 2075 S Cottonwood Dr, Tempe, AZ 85282-3040 | 2017-08-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346893575 | Cactus Canyon Dental | Dentist | 2043 E Southern Ave, Ste. C, Tempe, AZ 85282 | 2019-07-17 |
| 1023679644 | Donna Cooks | Registered Nurse | 233 E. Sourthern Ave #27702, Tempe, AZ 85282 | 2019-06-25 |
| 1841854932 | Lynn Stafford | Registered Nurse | 4041 S. Mcclintock, Ste 302, Tempe, AZ 85282 | 2019-04-24 |
| 1598227340 | Jane Ramenofsky Ramenofsky Stewart | Registered Nurse | 4041 So. Mcclintock Suite 302, Tempe, AZ 85282 | 2019-04-02 |
| 1588129902 | Mary K Wheeler Mcfarland | Registered Nurse | Adobe Care and Wellness LLC, Address Is 4041 S. Mcclintock, Ste 302, Tempe, AZ 85282 | 2019-02-11 |
| 1669949780 | Crestview Pharmacy Services LLC | Pharmacy | 3225 South Hardy Dr., Ste 100, Tempe, AZ 85282 | 2018-10-26 |
| 1275018715 | Berlin Wright | Naturopath | 2164 E. Broadway Rd., Tempe, AZ 85282 | 2018-10-01 |
| 1043701543 | Lakeshore Interventional Treatment Center LLC | Surgery | 4765 S Lakeshore Dr, Tempe, AZ 85282 | 2018-05-21 |
| 1427553940 | The Bridge Counseling, Consulting and Mediation LLC | Counselor | 4625 S. Lakeshore Dr., 302, Tempe, AZ 85282 | 2018-03-27 |
| 1346741501 | Coraesthetics Pllc | Physician Assistant | 2008 E Laguna Dr, Tempe, AZ 85282 | 2018-02-23 |
| Find all providers in zip 85282 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205187457 | Blessings of Joy Adult Care Home, LLC | Custodial Care Facility | 2532 E Huntington Dr, Tempe, AZ 85282-4162 | 2012-09-27 |
| 1528380524 | Arizona Care & Enrichment Services, Inc | Custodial Care Facility | 1655 E. Southern Ave, Apt 45, Tempe, AZ 85282 | 2010-02-18 |
| 1164624821 | Streams In The Desert Ministries, Inc. | Custodial Care Facility | 5612 S Heather Dr, Tempe, AZ 85283-2214 | 2007-06-04 |
| 1083957443 | Northstar Homecare | Custodial Care Facility | 750 W Baseline Rd, Tempe, AZ 85283-5903 | 2013-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861093783 | Rossana R. Barretto | Custodial Care Facility | 16948 W Magnolia St, Goodyear, AZ 85338-7428 | 2020-11-06 |
| 1467051508 | Lifes Journey LLC | Custodial Care Facility | 7591 N 85th Dr, Glendale, AZ 85305-3982 | 2020-10-20 |
| 1134736820 | Bernadette Tolentino Reyes | Custodial Care Facility | 2406 S Pecan Dr, Chandler, AZ 85286-7406 | 2020-09-26 |
| 1417567371 | Zaweah Luxury Living LLC | Custodial Care Facility | 9129 S 48th Dr, Laveen, AZ 85339-2242 | 2020-08-05 |
| 1932725835 | Oasis Group Home LLC | Custodial Care Facility | 2206 W. Spur Dr., Phoenix, AZ 85085-5752 | 2020-06-17 |
| 1821618679 | Klara's II Adult Care Home | Custodial Care Facility | 2974 E Pony Ct, Gilbert, AZ 85295-3775 | 2020-04-22 |
| 1932728581 | Michael Ford | Custodial Care Facility | 10462 E Abilene Ave, Mesa, AZ 85208-8717 | 2020-04-14 |
| 1588297006 | Marley Adult Healthcare LLC | Custodial Care Facility | 14798 W Georgia Dr, Surprise, AZ 85379-4243 | 2020-02-13 |
| 1841837499 | Gemini Group, LLC | Custodial Care Facility | 5045 E Paradise Ln, Scottsdale, AZ 85254-1045 | 2019-12-03 |
| 1457997744 | Dream Street Care LLC | Custodial Care Facility | 37412 N Dream Street, Carefree, AZ 85377 | 2019-11-21 |
| 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.