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General NPI Number Information
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NPI Number | 1578764049
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Entity Type | Organization
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Legal Business Name | JOLLEY FAMILY ASSISTED LIVING HOME II
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5042 N 86TH DR
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City | GLENDALE
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State | AZ
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Zip | 85305-3313
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Country | US
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Telephone | 623-872-0032
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Fax | 623-872-0033
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Provider Business Mailing Address
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Address Line | 5042 N 86TH DR
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City | GLENDALE
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State | AZ
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Zip | 85305-3313
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Country | US
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Telephone | 623-872-0032
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Fax | 623-872-0033
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. SHARON LENORE DUNCAN
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Credential |
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Telephone | 623-872-0032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | ALH-4290
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License Number State | AZ
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