Healthcare Provider Details

I. General information

NPI: 1093452831
Provider Name (Legal Business Name): HOUSE OF HOPE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 W MIRAGE LOOP
CASA GRANDE AZ
85122-6133
US

IV. Provider business mailing address

115 E 1ST ST
CASA GRANDE AZ
85122-5201
US

V. Phone/Fax

Practice location:
  • Phone: 520-421-1120
  • Fax: 520-421-2877
Mailing address:
  • Phone: 520-421-1120
  • Fax: 520-421-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: FOLASAYO O OLADOKUN
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 520-421-1120