Healthcare Provider Details

I. General information

NPI: 1619663978
Provider Name (Legal Business Name): HOPE MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23412 W PIMA ST
BUCKEYE AZ
85326-4044
US

IV. Provider business mailing address

23412 W PIMA ST
BUCKEYE AZ
85326-4044
US

V. Phone/Fax

Practice location:
  • Phone: 602-466-5921
  • Fax:
Mailing address:
  • Phone: 602-466-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PIERRE NKUNZIMANA
Title or Position: NURSE
Credential: NURSE
Phone: 602-466-5921