Provider Demographics
NPI:1356029888
Name:MORGAN, JASON ANDREW I
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:MORGAN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 S WATSON RD STE 103-421
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3452
Mailing Address - Country:US
Mailing Address - Phone:602-573-3738
Mailing Address - Fax:
Practice Address - Street 1:5709 S 231ST AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6150
Practice Address - Country:US
Practice Address - Phone:602-573-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care