Provider Demographics
NPI:1629599386
Name:JOVIAL RESIDENTIAL CARE
Entity Type:Organization
Organization Name:JOVIAL RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-876-7223
Mailing Address - Street 1:73 INDIAN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-5386
Mailing Address - Country:US
Mailing Address - Phone:505-876-7223
Mailing Address - Fax:505-832-3204
Practice Address - Street 1:1217 JELSO AVE
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3818
Practice Address - Country:US
Practice Address - Phone:505-876-7223
Practice Address - Fax:505-832-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility