Healthcare Provider Details

I. General information

NPI: 1588924351
Provider Name (Legal Business Name): HOPE FAMILY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 N BROAD ST
GLOBE AZ
85501-2503
US

IV. Provider business mailing address

PO BOX 1641
GLOBE AZ
85502-1641
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-8200
  • Fax: 928-425-8406
Mailing address:
  • Phone: 928-425-8200
  • Fax: 928-425-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1979
License Number StateAZ

VIII. Authorized Official

Name: KARRIE A MARIN
Title or Position: OFFICE MANAGER/AUTHORIZED OFFICIAL
Credential:
Phone: 928-425-8200