Provider Demographics
NPI:1740852391
Name:AVILA, JOVY
Entity type:Individual
Prefix:
First Name:JOVY
Middle Name:
Last Name:AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N ARIZONA AVE UNIT 1365
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-0716
Mailing Address - Country:US
Mailing Address - Phone:480-646-2772
Mailing Address - Fax:
Practice Address - Street 1:3759 E CLOVIS AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1841
Practice Address - Country:US
Practice Address - Phone:480-597-3303
Practice Address - Fax:480-597-3303
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11272H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility