MEDICARE: OPEN HEARTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	BH-1794	AZ
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	BH-1794	AZ
3	101Y00000X	Counselor	BH-1794	AZ
4	101YM0800X	Mental Health Counselor	BH-1794	AZ
5	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OTC6007	OTHER	AZ	ADHS

General Provider Information

NPI Number	:	1265544324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN HEARTS

Provider Business Mailing Address
First Line	:	PO BOX 86537
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85754-6537
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:	520-721-0069

Provider Business Practice Location Address
First Line	:	4414 N 19TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015
Country	:	US
Telephone Number	:	602-285-5550
Fax Number	:	602-285-5551

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	ROSE LOPEZ
Credential	:	MBA
Telephone Number	:	520-721-1887

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/19/2025

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Directions to “OPEN HEARTS ” Practice Location

Language	Start Address	Practice Location

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