Healthcare Provider Details

I. General information

NPI: 1952115263
Provider Name (Legal Business Name): DESERT HOPE CDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 N 35TH AVE
PHOENIX AZ
85017-5253
US

IV. Provider business mailing address

2923 N 35TH AVE
PHOENIX AZ
85017-5253
US

V. Phone/Fax

Practice location:
  • Phone: 602-770-0954
  • Fax:
Mailing address:
  • Phone: 602-770-0954
  • Fax:

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD E JONES
Title or Position: DIRECTOR
Credential:
Phone: 602-770-0954