MEDICARE: ESPERANZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	BH2437	AZ

General Provider Information

NPI Number	:	1326271727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESPERANZA

Provider Business Mailing Address
First Line	:	PO BOX 2779
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-1040
Country	:	US
Telephone Number	:	520-466-8850
Fax Number	:	520-466-8851

Provider Business Practice Location Address
First Line	:	11140 W COVE DR
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-5486
Country	:	US
Telephone Number	:	520-466-8850
Fax Number	:	520-466-8851

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RAYMOND ERNEST LINAFELTER
Credential	:
Telephone Number	:	520-466-8852

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/01/2009

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Directions to “ESPERANZA ” Practice Location

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