Provider Demographics
NPI:1609642958
Name:JENCARE COUNSELING AND COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:JENCARE COUNSELING AND COMMUNITY SERVICES LLC
Other - Org Name:JENCARE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-696-2086
Mailing Address - Street 1:7035 S 77TH LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7232
Mailing Address - Country:US
Mailing Address - Phone:623-289-7140
Mailing Address - Fax:
Practice Address - Street 1:5957 W NORTHERN AVE STE 117
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-7825
Practice Address - Country:US
Practice Address - Phone:623-289-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit