Provider Demographics
NPI:1386107522
Name:JOYFUL BEHAVIORAL HEALTH RESIDENTIAL CARE
Entity type:Organization
Organization Name:JOYFUL BEHAVIORAL HEALTH RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OHUNRERETUNDE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADEBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-476-4616
Mailing Address - Street 1:16274 W SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3535
Mailing Address - Country:US
Mailing Address - Phone:602-476-4204
Mailing Address - Fax:
Practice Address - Street 1:16274 W SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3535
Practice Address - Country:US
Practice Address - Phone:602-476-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5725Medicaid