Healthcare Provider Details

I. General information

NPI: 1881440675
Provider Name (Legal Business Name): JOSIES HOPE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1945 W VAN BUREN ST
PHOENIX AZ
85009-3805
US

IV. Provider business mailing address

8006 S 38TH PL
PHOENIX AZ
85042-9621
US

V. Phone/Fax

Practice location:
  • Phone: 480-934-3033
  • Fax:
Mailing address:
  • Phone: 480-934-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MICHAEL ANTHONY JOHNSON JR.
Title or Position: OWNER
Credential:
Phone: 480-934-3033