Healthcare Provider Details

I. General information

NPI: 1174667125
Provider Name (Legal Business Name): HOUSE OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W KAIBAB WAY
COCHISE AZ
85606-8710
US

IV. Provider business mailing address

424 W KAIBAB WAY
COCHISE AZ
85606-8710
US

V. Phone/Fax

Practice location:
  • Phone: 520-826-4065
  • Fax: 520-826-1716
Mailing address:
  • Phone: 520-826-4065
  • Fax: 520-826-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberALH-2895
License Number StateAZ

VIII. Authorized Official

Name: MRS. BARBARA ANN HART
Title or Position: MANAGER OWNER
Credential: LICENSE PRACTICALNUR
Phone: 520-826-4065