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Organization

POTTERVILLE CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TAIWO AJAYI PHD (MANAGING MEMBER)
(623) 312-8093
Entity
Organization

Contact information

Practice address
3107 E FRANKLIN AVE, GILBERT, AZ 85295-9093
(623) 312-8093
Mailing address
3107 E FRANKLIN AVE, GILBERT, AZ 85295-9093
(623) 312-8093

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
251E00000X
Home Health Agency
251J00000X
Nursing Care Agency
251S00000X
Community/Behavioral Health Agency
Primary
261QH0100X
Health Service Clinic/Center
314000000X
Skilled Nursing Facility
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
385HR2065X
Child Physical Disabilities Respite Care

Other

Enumeration date
06/15/2022
Last updated
06/15/2022
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