Healthcare Provider Details

I. General information

NPI: 1184240731
Provider Name (Legal Business Name): EMBRACE HOPE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 W KERBY AVE
PHOENIX AZ
85043-1677
US

IV. Provider business mailing address

7707 W KERBY AVE
PHOENIX AZ
85043-1677
US

V. Phone/Fax

Practice location:
  • Phone: 641-781-1444
  • Fax:
Mailing address:
  • Phone: 641-781-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: EDIDIONG EFFIONG
Title or Position: CEO
Credential:
Phone: 641-781-1444