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General NPI Number Information
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NPI Number | 1215538111
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Entity Type | Organization
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Legal Business Name | HOPE & HAVEN FAMILY SERVICES LLC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 3015 N SCOTTSDALE RD UNIT 4222
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7262
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Country | US
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Telephone | 773-661-8193
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Fax | 999-999-9999
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Provider Business Mailing Address
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Address Line | 644 N COUNTRY CLUB DR STE C
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City | MESA
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State | AZ
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Zip | 85201-4983
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Country | US
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Telephone | 773-661-8193
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Fax | 999-999-9999
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Authorized Official
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Title or Position | OWNER
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Name | LASHONIA SHASHERAH PENNIX
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Credential | OWNER
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Telephone | 773-661-8193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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