Healthcare Provider Details

I. General information

NPI: 1174210041
Provider Name (Legal Business Name): HEARTS OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 E BEVERLY LN
PHOENIX AZ
85022-2915
US

IV. Provider business mailing address

10904 E SEBRING AVE
MESA AZ
85212-5229
US

V. Phone/Fax

Practice location:
  • Phone: 480-984-1795
  • Fax: 480-984-1795
Mailing address:
  • Phone: 480-399-3727
  • Fax: 480-984-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ELVIS DICKSON
Title or Position: CO-FOUNDER/GEN PART
Credential:
Phone: 480-984-1795