Provider Demographics
NPI:1093206427
Name:SPRINGS OF JOY LLC.
Entity Type:Organization
Organization Name:SPRINGS OF JOY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:NYAWIRA
Authorized Official - Last Name:GITOGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-228-7140
Mailing Address - Street 1:613 S 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-8447
Mailing Address - Country:US
Mailing Address - Phone:253-228-7140
Mailing Address - Fax:
Practice Address - Street 1:613 S 125TH AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-8447
Practice Address - Country:US
Practice Address - Phone:253-228-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5278320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities