Healthcare Provider Details

I. General information

NPI: 1124195284
Provider Name (Legal Business Name): CASA DE ESPERANZA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 S PARK CENTRE AVE
GREEN VALLEY AZ
85614-5127
US

IV. Provider business mailing address

780 S PARK CENTRE AVE
GREEN VALLEY AZ
85614-5127
US

V. Phone/Fax

Practice location:
  • Phone: 520-625-2273
  • Fax:
Mailing address:
  • Phone: 520-625-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberAL0553D
License Number StateAZ

VIII. Authorized Official

Name: MR. WILLIAM T MCCREERY
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 520-625-2273