Healthcare Provider Details

I. General information

NPI: 1841837499
Provider Name (Legal Business Name): GEMINI GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 E PARADISE LN
SCOTTSDALE AZ
85254-1045
US

IV. Provider business mailing address

PO BOX 1213
CAREFREE AZ
85377-1213
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-7101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DEITCHMAN
Title or Position: MANAGER
Credential:
Phone: 480-455-7975