MEDICARE: HOUSE OF HOPE

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	324500000X	Substance Abuse Rehabilitation Facility	11715	UT

General Provider Information

NPI Number	:	1770696635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE OF HOPE

Provider Business Mailing Address
First Line	:	857 E 200 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2334
Country	:	US
Telephone Number	:	801-487-3276
Fax Number	:	801-467-3725

Provider Business Practice Location Address
First Line	:	857 E 200 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2334
Country	:	US
Telephone Number	:	801-487-3276
Fax Number	:	801-467-3725

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LISA HEATON
Credential	:	LCSW
Telephone Number	:	801-487-3276

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/16/2017

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