Provider Demographics
NPI:1205504495
Name:JEZZOB BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:JEZZOB BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FACILITY OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZEBEDEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:YONG
Authorized Official - Suffix:
Authorized Official - Credentials:GSP/ASHM
Authorized Official - Phone:602-521-2351
Mailing Address - Street 1:7409 W SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-2058
Mailing Address - Country:US
Mailing Address - Phone:602-521-2351
Mailing Address - Fax:480-718-8860
Practice Address - Street 1:7409 W SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-2058
Practice Address - Country:US
Practice Address - Phone:602-521-2351
Practice Address - Fax:480-718-8860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1730701517
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1981Medicaid