Provider Demographics
NPI:1255999819
Name:JESA HOMES LLC
Entity type:Organization
Organization Name:JESA HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MBONG
Authorized Official - Middle Name:JERRY
Authorized Official - Last Name:NGWESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-233-9241
Mailing Address - Street 1:2328 WEST DARREL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041
Mailing Address - Country:US
Mailing Address - Phone:480-233-9241
Mailing Address - Fax:602-276-5063
Practice Address - Street 1:2546 WEST BLOCH RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041
Practice Address - Country:US
Practice Address - Phone:480-233-9241
Practice Address - Fax:602-276-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness