Healthcare Provider Details

I. General information

NPI: 1609448844
Provider Name (Legal Business Name): HOPE RESTORATION MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6114 S FONTANA AVENUE
TUCSON AZ
85706-4044
US

IV. Provider business mailing address

4214 W FIRETHORN ST
TUCSON AZ
85741-4044
US

V. Phone/Fax

Practice location:
  • Phone: 520-261-0818
  • Fax:
Mailing address:
  • Phone: 520-304-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE LYNN BERT
Title or Position: CHIEF OPERATING OFFICER
Credential: LAC
Phone: 520-304-3389