Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Hacienda Inc

Organization Custodial Care Facility · NPI 1841513413

Hacienda Inc is a Custodial Care Facility in Phoenix, Arizona. Licensed in Arizona. Registered with an NPI since 2010.

Licensed in
AZ
In the registry since
2010
Specialties on file
2
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1402 E South Mountain Ave
Phoenix, AZ 85042-7925
Phone: (602) 243-4231
Fax: (602) 323-5988
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual Disabilities Intermediate Care Facility (primary) Taxonomy 315P00000X
Custodial Care Facility Taxonomy 311Z00000X · Licence DDH1558 (AZ)

Record details

NPI number1841513413
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Perry Petrilli — Ceo · (602) 243-4231
Other names Hacienda Hcbs; Hacienda Hcbs
NPI enumeratedMarch 10, 2010
Last updated in NPPESFebruary 13, 2025
Certification dateFebruary 13, 2025
Mailing address1402 E South Mountain Ave, Phoenix, AZ 85042-7925

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