HACIENDA INC
NPI 1417178724
Intermediate Care Facility, Intellectual Disabilities in Phoenix, AZ
NPI Status: Active since May 02, 2007
Contact Information
1402 E SOUTH MOUNTAIN AVE
PHOENIX, AZ
ZIP 85042
Phone: (602) 243-4231
Fax: (602) 323-5988
- Organization
- Intermediate Care Facility, Intellectual...
- CLIA Number: 03D0980237
- CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
- CLIA Exp. Date: 01-01-2028
About HACIENDA INC
This page provides the complete NPI Profile along with additional information for Hacienda Inc, a provider established in Phoenix, Arizona operating as a Intermediate Care Facility, Intellectual Disabilities. The healthcare provider is registered in the NPI registry with number 1417178724 assigned on May 2007. The practitioner's primary taxonomy code is 315P00000X with license number LTC0176 (AZ). The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Perry Petrilli (Ceo)
- NPI
- 1417178724
- Provider Name
- HACIENDA INC
- Entity Type
- Organization
- Location Address
- 1402 E SOUTH MOUNTAIN AVE PHOENIX, AZ 85042
- Location Phone
- (602) 243-4231
- Location Fax
- (602) 323-5988
- Mailing Address
- 1402 E SOUTH MOUNTAIN AVE PHOENIX, AZ 85042
- Mailing Phone
- (602) 243-4231
- Mailing Fax
- (602) 323-5988
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-02-2007
- Last Update Date
- 02-13-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Intermediate Care Facility, Intellectual Disabilities
- Taxonomy Code
- 315P00000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- LTC0176
- License State
- AZ
- Taxonomy Description
- An intermediate care facility providing services for individuals with intellectual disabilities.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 040064 | MEDICAID (05) | AZ | |
| ICF001 | MEDICAID (05) | AZ |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 03D0980237
- Facility Type
- Skilled Nursing Facility/Nursing Facility
- Certificate Effective Date
- January 02, 2026
- Certificate Expiration Date
- January 01, 2028
- Laboratory Director
- LORENA BOWERS
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Hacienda Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1417178724, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 66 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 10 providers are registered at the same or a nearby location.
PHOENIX, AZ 85042
PHOENIX, AZ 85042
PHOENIX, AZ 85042
PHOENIX, AZ 85042
PHOENIX, AZ 85042
PHOENIX, AZ 85042
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1417178724, enumerated as an "organization" on May 02, 2007.
The provider is located at 1402 E SOUTH MOUNTAIN AVE PHOENIX, AZ 85042 and the phone number is (602) 243-4231.
Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
