Provider Demographics
NPI:1811108897
Name:JENNINGS SOUTH, INC.
Entity type:Organization
Organization Name:JENNINGS SOUTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:II
Authorized Official - Credentials:COO
Authorized Official - Phone:513-325-9304
Mailing Address - Street 1:3327 N CIVIC CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6404
Mailing Address - Country:US
Mailing Address - Phone:480-946-7111
Mailing Address - Fax:480-945-2344
Practice Address - Street 1:3327 N CIVIC CENTER PLZ
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6404
Practice Address - Country:US
Practice Address - Phone:480-946-7111
Practice Address - Fax:480-945-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC 4470310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ820565Medicare ID - Type UnspecifiedADULT LONG TERM CARE