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General NPI Number Information
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NPI Number | 1184315012
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Entity Type | Organization
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Legal Business Name | JADEM ARK OF HOPE, LLC
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 1214 E FAIRMONT DR
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City | TEMPE
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State | AZ
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Zip | 85282-3938
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Country | US
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Telephone | 480-284-5590
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Fax |
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Provider Business Mailing Address
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Address Line | 10370 W ODEUM LN
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City | TOLLESON
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State | AZ
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Zip | 85353-4194
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Country | US
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Telephone | 206-334-3511
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Fax |
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Authorized Official
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Title or Position | CHIEF ORGANIZATION
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Name | MERCY NKENGAWUNG NKEZE
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Credential | PHARMD
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Telephone | 206-334-3511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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