Healthcare Provider Details

I. General information

NPI: 1336770361
Provider Name (Legal Business Name): ANCHORED HEARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10428 E OSAGE AVE
MESA AZ
85212-1803
US

IV. Provider business mailing address

501 S 48TH ST STE 110
TEMPE AZ
85281-2313
US

V. Phone/Fax

Practice location:
  • Phone: 480-232-8600
  • Fax: 480-444-1452
Mailing address:
  • Phone: 480-232-8600
  • Fax: 480-444-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAYLA SOL
Title or Position: CEO
Credential:
Phone: 480-232-8600