Provider Demographics
NPI:1275377483
Name:TUMBLEWEED CLUB, LLC
Entity type:Organization
Organization Name:TUMBLEWEED CLUB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:JOSEPOH
Authorized Official - Last Name:CLARIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-246-1000
Mailing Address - Street 1:13210 W VAN BUREN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1164
Mailing Address - Country:US
Mailing Address - Phone:623-300-2858
Mailing Address - Fax:
Practice Address - Street 1:13210 W VAN BUREN ST STE 112
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1164
Practice Address - Country:US
Practice Address - Phone:623-300-2858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No332U00000XSuppliersHome Delivered Meals