Individual
JEAN GASORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9840 E CELESTE DR, TUCSON, AZ 85730-3037
(520) 339-1149
Mailing address
4000 N CENTRAL AVE STE 100, PHOENIX, AZ 85012-3520
(602) 283-1573
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH9657
AZ
385H00000X
Respite Care
BH9657
AZ
Other
Enumeration date
02/01/2024
Last updated
05/01/2024
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