Provider Demographics
NPI:1386008076
Name:HOPE BEHAVIORAL HEALTH RESIDENTIAL CARE
Entity type:Organization
Organization Name:HOPE BEHAVIORAL HEALTH RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ODETOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-925-8606
Mailing Address - Street 1:15985 W WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9433
Mailing Address - Country:US
Mailing Address - Phone:623-925-2515
Mailing Address - Fax:
Practice Address - Street 1:15985 W.WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338
Practice Address - Country:US
Practice Address - Phone:623-925-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4881324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility