Provider Demographics
NPI:1407911217
Name:MCCOY, JORETTA JOYCE
Entity Type:Individual
Prefix:
First Name:JORETTA
Middle Name:JOYCE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26855 S COOPERS HAWK RD
Mailing Address - Street 2:
Mailing Address - City:AMADO
Mailing Address - State:AZ
Mailing Address - Zip Code:85645-9571
Mailing Address - Country:US
Mailing Address - Phone:520-398-3311
Mailing Address - Fax:520-398-3322
Practice Address - Street 1:26855 S COOPERS HAWK RD
Practice Address - Street 2:
Practice Address - City:AMADO
Practice Address - State:AZ
Practice Address - Zip Code:85645-9571
Practice Address - Country:US
Practice Address - Phone:520-398-3311
Practice Address - Fax:520-398-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ041438Medicare ID - Type Unspecified