| Organization Name: | CLARENCE & JEANNE KINSLEY, DBA |
| NPI Number: | 1255703229 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEANNE MARIE KINSLEY (OWNER/CHILDRENS RESPITE PROVIDER) |
| Mailing Address: | 17100 E. Lions Crossing Rd Dewey |
| State: | AZ US |
| Postal Code: | 86327 |
| Phone Number: | 9287728070 |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2015 |
| NPI Last Update Date: | 10/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385HR2055X |
| License Number: | BH4541 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | Respite Care, Mental Illness, Child |
| Taxonomy Definition: | A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers. |