Provider Demographics
NPI:1386960227
Name:FORBES, JAIMIE D (MSPT)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:D
Last Name:FORBES
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12251 W BLACKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2427
Mailing Address - Country:US
Mailing Address - Phone:480-205-2724
Mailing Address - Fax:623-444-7153
Practice Address - Street 1:12251 W BLACKSTONE CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2427
Practice Address - Country:US
Practice Address - Phone:480-205-2724
Practice Address - Fax:623-444-7153
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5230314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility