Provider Demographics
NPI:1598025934
Name:HOUSE OF HOPE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:HOUSE OF HOPE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-709-1586
Mailing Address - Street 1:65 N POTTEBAUM RD.
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5326
Mailing Address - Country:US
Mailing Address - Phone:602-618-3756
Mailing Address - Fax:602-325-0405
Practice Address - Street 1:1149 E 11TH ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-3609
Practice Address - Country:US
Practice Address - Phone:520-709-1586
Practice Address - Fax:602-325-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH4017OtherARIZONA DEPARTMENT OF HEALTH