Provider Demographics
NPI:1255703229
Name:CLARENCE & JEANNE KINSLEY, DBA
Entity type:Organization
Organization Name:CLARENCE & JEANNE KINSLEY, DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHILDRENS RESPITE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-772-8070
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-0102
Mailing Address - Country:US
Mailing Address - Phone:928-772-8070
Mailing Address - Fax:
Practice Address - Street 1:17100 E. LIONS CROSSING RD
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327
Practice Address - Country:US
Practice Address - Phone:928-772-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4541385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child