=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285261891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE & HEALING ADDICTION TREATMENT CENTERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2020
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 E LONE CACTUS DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85024-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-900-5557
-----------------------------------------------------
Fax | 602-374-3197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 67 S HIGLEY RD STE 103-208
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85296-1166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-868-8697
-----------------------------------------------------
Fax | 906-374-3197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | CASSANDRA FORTSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-868-8697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------