Healthcare Provider Details

I. General information

NPI: 1104581479
Provider Name (Legal Business Name): ONWARD HOPE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 W CAMELBACK ROAD
PHOENIX AZ
85013-2127
US

IV. Provider business mailing address

1408 W CAMELBACK ROAD
PHOENIX AZ
85013-2127
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-2723
  • Fax: 480-323-2114
Mailing address:
  • Phone: 602-441-2723
  • Fax: 480-323-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ESHAWN A PETERSON
Title or Position: CEO & PRESIDENT
Credential:
Phone: 602-441-2723