Healthcare Provider Details

I. General information

NPI: 1083301048
Provider Name (Legal Business Name): HOPE INTEGRATED CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 E GRANT RD STE 100
TUCSON AZ
85716-2840
US

IV. Provider business mailing address

5220 E FAIRY DUSTER DR
TUCSON AZ
85756-5140
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-1423
  • Fax:
Mailing address:
  • Phone: 480-306-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: GIFT MUTESI
Title or Position: OWNER
Credential:
Phone: 480-306-1423