Healthcare Provider Details

I. General information

NPI: 1245762087
Provider Name (Legal Business Name): HEARTH HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 E PHELPS RD
PHOENIX AZ
85032-2822
US

IV. Provider business mailing address

4435 E PHELPS RD
PHOENIX AZ
85032-2822
US

V. Phone/Fax

Practice location:
  • Phone: 602-218-8860
  • Fax: 602-218-8860
Mailing address:
  • Phone: 602-218-8860
  • Fax: 602-218-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH5132
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH5132
License Number StateAZ

VIII. Authorized Official

Name: MRS. AVA YOLANDE HECTOR
Title or Position: ADMINISTRATOR
Credential: B.SC/BHT
Phone: 602-218-8860