Janelle Hultman

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

BH-2695 Issued in AZ

Legal business name

JANELLE HULTMAN

Practice address

13401 W Fargo Dr
Surprise, AZ 85374-5205

Phone

(623) 581-5687

NPI assigned

Jan 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janelle Evonne Hultman

Title

Administrator

Phone

(623) 581-5687

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952457392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13401 W FARGO DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853745205",
            "telephone_number": "623-581-5687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13401 W FARGO DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853745205",
            "telephone_number": "623-581-5687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANELLE HULTMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HULTMAN",
        "authorized_official_first_name": "JANELLE",
        "authorized_official_middle_name": "EVONNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "623-581-5687"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "AZ",
            "license": "BH-2695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118632",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "BH-2695",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David F. James, DDS
• Kylie Delen James
• Tracey J James, LPC
• Edelita Remegoso Jamis, MD
• Roel Conrad Jamis
• Janelle Janssen
• Jocelyn Jasper, OWNER
• Parita Javia
• Stephanie Jenkins, R.N.
• Gretchen Jennings, ED.S

• Assisted Living Facility (Mental Illness) in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Assisted Living Facility (Mental Illness) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.