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NPI 1609600105ActiveOrganization· Custodial Care Facility· Peoria, AZ
Custodial Care Facility in Peoria, Arizona, registered in NPPES in August 2024. The authorized official on file is Deatra Johnson, Executive Director.
Overview
| NPI | 1609600105 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 27, 2024 |
| Last updated in NPPES | Aug 27, 2024 |
| Certified by provider | Aug 27, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Custodial Care Facility Primary | 311Z00000X | — | — |
| Assisted Living Facility | 310400000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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