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General NPI Number Information
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NPI Number | 1972820371
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Entity Type | Organization
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Legal Business Name | ANGELS OF HOPE BEHAVIORAL HEALTH RESIDENTIAL AGENCY
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 483 W GASCON RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85143-5467
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Country | US
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Telephone | 480-628-4614
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Fax | 480-699-9761
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Provider Business Mailing Address
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Address Line | 483 W GASCON RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85143-5467
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Country | US
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Telephone | 480-628-4614
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Fax | 480-699-9761
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. LATONYA DENISE JACKSON
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Credential |
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Telephone | 480-628-4614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | BH3556
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License Number State | AZ
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