STAROAKS BEHAVIORAL HOME (NPI# 1023506300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023506300 |
| Entity Type | Organization |
| Organization Name | STAROAKS BEHAVIORAL HOME |
| Practice Address |
17644 N 17th St Phoenix AZ 85022-2113 |
| Practice Telephone | 7139096953 |
| Mailing Telephone | 7139096953 |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2018-04-23 |
| Authorized Official Name | AUGUSTINA OMOGHENE ITIMI (ADMINISTRATOR) |
| Authorized Official Telephone | 7139096953 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | BH5418 | AZ | Nursing & Custodial Care Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 17644 N 17th St, Phoenix, AZ 850222113 | 7139096953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285284539 | Staroaks Behavioral Home | Community Based Residential Treatment Facility, Mental Illness | 1112 E Irma Ln, Phoenix, AZ 85024-4118 | 2019-09-18 |
| 1710438460 | Staroaks Behavioral Home | Behavior Technician | 2016 E Rockwood Dr, Phoenix, AZ 85024-3076 | 2016-10-18 |
| Street Address |
17644 N 17TH ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85022-2113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528626074 | Keauna Olugu | Psychologist | 17249 N. 7th St, 1128, Phoenix, AZ 85022 | 2019-05-30 |
| 1215455498 | Kristi Etchechury | Occupational Therapy Assistant | 807 East Beck Lane, Phoenix, AZ 85022 | 2017-09-07 |
| 1871017103 | Julie Dale | Physical Therapist | 1910 E Kathleen Rd, Phoenix, AZ 85022 | 2017-07-28 |
| 1669994539 | Valley Wellness Center Pllc | Clinic/Center | 702 E Bell Rd Ste 112, Phoenix, AZ 85022 | 2017-07-12 |
| 1386001758 | Debbie Mulder | Behavioral Analyst | 2400 West Dunlap Ave., Suite 100, Glendale, AZ 85022 | 2016-01-15 |
| 1114383437 | Jean Fay King | Nurse Practitioner | 15409 N. 23rd St., Phoenix, AZ 85022 | 2016-01-04 |
| 1093050767 | Cheyanne Wilderness Gastelum | Midwife | 2236 E. Delgado St., Phoenix, AZ 85022 | 2012-12-06 |
| 1760731236 | Nicole Ann Raus | Occupational Therapy Assistant | 15414 N. 7th Street, Suite 3, Phoenix, AZ 85022 | 2012-08-30 |
| 1144593211 | Edward Najeeb Abraham | Family Medicine | 14419 N. 5th Place, Phoenix, AZ 85022 | 2012-02-20 |
| 1942506019 | Mirnes Mehic | Assisted Living Facility | 2018 E. Wagoner Rd., Phoenix, AZ 85022 | 2011-02-07 |
| Find all providers in zip 85022 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942800966 | Yibu Liu | Assisted Living Facility | 3569 E Utopia Rd, Phoenix, AZ 85050-3967 | 2020-10-28 |
| 1609474030 | Fisher Family Home LLC | Assisted Living Facility | 2927 W Redfield Rd, Phoenix, AZ 85053-7712 | 2020-10-16 |
| 1235736687 | Ana's Assisted Living Home, LLC | Assisted Living Facility | 13238 N 35th St, Phoenix, AZ 85032-6110 | 2020-10-07 |
| 1881201598 | Latins Home LLC | Assisted Living Facility | 10601 S 42nd St, Phoenix, AZ 85044-1301 | 2020-09-26 |
| 1659987998 | Mehry Lyn Moses | Assisted Living Facility | 1816 E Whitton Ave, Phoenix, AZ 85016-6416 | 2020-09-22 |
| 1417562406 | Briceida Rocha | Assisted Living Facility | 1345 W Atlanta Ave, Phoenix, AZ 85041-3929 | 2020-09-15 |
| 1073127213 | Marlyn Ll Joaquin | Assisted Living Facility | 1349 W Rosemonte Dr, Phoenix, AZ 85027-5444 | 2020-09-04 |
| 1720602832 | Casa De Vida Living LLC | Assisted Living Facility | 7036 W Parkway Dr, Phoenix, AZ 85043-6921 | 2020-06-04 |
| 1689295297 | Raj International LLC | Assisted Living Facility | 4312 E Redwood Ln, Phoenix, AZ 85048-7028 | 2020-05-05 |
| 1285261891 | Sterling Residences, LLC | Assisted Living Facility | 2301 E Lone Cactus Dr, Phoenix, AZ 85024-5507 | 2020-03-24 |
| Find all providers in PHOENIX | ||||
Please comment or provide details below to improve the information on STAROAKS BEHAVIORAL HOME.
| 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.