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General NPI Number Information
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NPI Number | 1588426266
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Entity Type | Organization
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Legal Business Name | LIVING HOPE CLINIC LLC
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 5251 W CAMPBELL AVE STE 208
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City | PHOENIX
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State | AZ
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Zip | 85031-1719
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Country | US
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Telephone | 207-966-6134
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Fax |
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Provider Business Mailing Address
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Address Line | 5251 W CAMPBELL AVE STE 208
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City | PHOENIX
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State | AZ
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Zip | 85031-1719
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Country | US
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Telephone | 207-966-6134
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JUSTIN NIZEYE JENSON
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Credential |
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Telephone | 207-699-6134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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