Provider Demographics
NPI:1629712351
Name:JOONDALUP PRESTIGE LLC
Entity Type:Organization
Organization Name:JOONDALUP PRESTIGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:WENDY
Authorized Official - Last Name:MUTHONI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:858-344-4746
Mailing Address - Street 1:8509 S 41ST DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7823
Mailing Address - Country:US
Mailing Address - Phone:858-344-4746
Mailing Address - Fax:520-455-3200
Practice Address - Street 1:7836 S 45TH AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-5456
Practice Address - Country:US
Practice Address - Phone:858-344-4746
Practice Address - Fax:520-455-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness