Healthcare Provider Details

I. General information

NPI: 1508576240
Provider Name (Legal Business Name): MJW VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 E TUNGSTEN DR
MESA AZ
85212-8488
US

IV. Provider business mailing address

9930 E TUNGSTEN DR
MESA AZ
85212-8488
US

V. Phone/Fax

Practice location:
  • Phone: 925-804-1154
  • Fax:
Mailing address:
  • Phone: 925-804-1154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMEKA HARGROVE
Title or Position: CEO
Credential:
Phone: 925-804-1154