Provider Demographics
NPI:1730701517
Name:JEZZOB BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:JEZZOB BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZEBEDEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:YONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-521-2351
Mailing Address - Street 1:4918 W APOLLO RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-6289
Mailing Address - Country:US
Mailing Address - Phone:602-521-2351
Mailing Address - Fax:480-718-8860
Practice Address - Street 1:4918 W APOLLO RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-6289
Practice Address - Country:US
Practice Address - Phone:602-521-2351
Practice Address - Fax:480-718-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty