Healthcare Provider Details

I. General information

NPI: 1376074120
Provider Name (Legal Business Name): NEW HOPE OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 W GLASS LN
PHOENIX AZ
85041-6152
US

IV. Provider business mailing address

12406 N 32ND ST STE 101
PHOENIX AZ
85032-7146
US

V. Phone/Fax

Practice location:
  • Phone: 602-535-5686
  • Fax: 602-535-5912
Mailing address:
  • Phone: 602-535-5686
  • Fax: 602-535-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW JOHN BEATY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 602-535-5686