Provider Demographics
NPI:1265884092
Name:JAYLARAY CAREGIVIN PLACE, LLC
Entity type:Organization
Organization Name:JAYLARAY CAREGIVIN PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BST WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-336-1082
Mailing Address - Street 1:2470 WRONDEL WAY
Mailing Address - Street 2:275
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3701
Mailing Address - Country:US
Mailing Address - Phone:775-336-1082
Mailing Address - Fax:775-336-1082
Practice Address - Street 1:2470 WRONDEL WAY
Practice Address - Street 2:275
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3701
Practice Address - Country:US
Practice Address - Phone:775-336-1082
Practice Address - Fax:775-336-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness