Organization
JESA HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MBONG JERRY NGWESE (CO-OWNER)
(480) 233-9241
Entity
Organization
Contact information
Practice address
2328 W DARREL RD, PHOENIX, AZ 85041-6412
(602) 268-1767
(602) 268-1277
Mailing address
2328 W DARREL RD, PHOENIX, AZ 85041-6412
(602) 268-1767
(602) 268-1277
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
BH3810
AZ
Other
Enumeration date
04/14/2011
Last updated
04/14/2011
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