Organization
POTTERVILLE CARE LLC
Active
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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