1972646149 NPI number — JELODON HC, LLC

Table of content: (NPI 1972646149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972646149 NPI number — JELODON HC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JELODON HC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NURSING SOLUTIONS OF SOUTHERN ARIZONA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972646149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15255 N 40TH STREET, STE 141
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-331-1100
Provider Business Mailing Address Fax Number:
602-331-1204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2980 N CAMPBELL AVE STE 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85719-7402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-886-6620
Provider Business Practice Location Address Fax Number:
520-751-9242
Provider Enumeration Date:
02/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EDMUNDSON
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
903-532-1400

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA-0263 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)