Organization
JESA HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MBONG JERRY NGWESE (PROGRAM DIRECTOR)
(480) 233-9241
Entity
Organization
Contact information
Practice address
2546 WEST BLOCH RD, PHOENIX, AZ 85041
(480) 233-9241
(602) 276-5063
Mailing address
2328 WEST DARREL RD, PHOENIX, AZ 85041
(480) 233-9241
(602) 276-5063
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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