Healthcare Provider Details

I. General information

NPI: 1386107522
Provider Name (Legal Business Name): JOYFUL BEHAVIORAL HEALTH RESIDENTIAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16274 W SUPERIOR AVE
GOODYEAR AZ
85338-3535
US

IV. Provider business mailing address

16274 W SUPERIOR AVE
GOODYEAR AZ
85338-3535
US

V. Phone/Fax

Practice location:
  • Phone: 602-476-4616
  • Fax:
Mailing address:
  • Phone: 602-476-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: OHUNRERETUNDE J ADEBOLA
Title or Position: CEO
Credential:
Phone: 602-476-4616