Provider Demographics
NPI:1245860683
Name:JMJ ENTERPISE LLC
Entity type:Organization
Organization Name:JMJ ENTERPISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-628-7207
Mailing Address - Street 1:14804 N 130TH LN
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3436
Mailing Address - Country:US
Mailing Address - Phone:623-428-4429
Mailing Address - Fax:
Practice Address - Street 1:14547 W ACAPULCO LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8548
Practice Address - Country:US
Practice Address - Phone:623-428-4429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness