Healthcare Provider Details

I. General information

NPI: 1871659318
Provider Name (Legal Business Name): MRS. JO ANNE RYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 N TEWKSBURG BLVD
YOUNG AZ
85554
US

IV. Provider business mailing address

PO BOX 131 698 N TEWKSBURG BLVD
YOUNG AZ
85554
US

V. Phone/Fax

Practice location:
  • Phone: 928-462-3253
  • Fax: 928-462-6644
Mailing address:
  • Phone: 928-462-3253
  • Fax: 928-462-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: