Healthcare Provider Details

I. General information

NPI: 1629599386
Provider Name (Legal Business Name): JOVIAL RESIDENTIAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 JELSO AVE
GRANTS NM
87020-3818
US

IV. Provider business mailing address

73 INDIAN HILLS RD
MORIARTY NM
87035-5386
US

V. Phone/Fax

Practice location:
  • Phone: 505-876-7223
  • Fax: 505-832-3204
Mailing address:
  • Phone: 505-876-7223
  • Fax: 505-832-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARA ROBINSON
Title or Position: RESIDENTIAL DIRECTOR
Credential:
Phone: 505-876-7223