Healthcare Provider Details

I. General information

NPI: 1992627533
Provider Name (Legal Business Name): JUNEBUG KIDZ AZ, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N GILBERT RD APT 1107
GILBERT AZ
85234-8611
US

IV. Provider business mailing address

1101 N GILBERT RD APT 1107
GILBERT AZ
85234-8611
US

V. Phone/Fax

Practice location:
  • Phone: 602-812-0526
  • Fax:
Mailing address:
  • Phone: 602-812-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANA L ALLEN
Title or Position: OWNER
Credential: SLPA
Phone: 602-812-0526