Healthcare Provider Details

I. General information

NPI: 1609642958
Provider Name (Legal Business Name): JENCARE COUNSELING AND COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5957 W NORTHERN AVE STE 117
GLENDALE AZ
85301-7825
US

IV. Provider business mailing address

7035 S 77TH LN
LAVEEN AZ
85339-7232
US

V. Phone/Fax

Practice location:
  • Phone: 623-289-7140
  • Fax:
Mailing address:
  • Phone: 623-289-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LOFTERS
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 602-696-2086