Healthcare Provider Details

I. General information

NPI: 1659297364
Provider Name (Legal Business Name): CRADLE OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E ROESER RD
PHOENIX AZ
85040-3707
US

IV. Provider business mailing address

2950 E ROESER RD
PHOENIX AZ
85040-3707
US

V. Phone/Fax

Practice location:
  • Phone: 520-445-2537
  • Fax:
Mailing address:
  • Phone: 520-445-2537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ALVIN KONGNYUY
Title or Position: CEO
Credential:
Phone: 983-209-9898