MEDICARE: HOPE & HEALING ADDICTION TREATMENT CENTERS LLC

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	323P00000X	Psychiatric Residential Treatment Facility
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1285261891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE & HEALING ADDICTION TREATMENT CENTERS LLC

Provider Business Mailing Address
First Line	:	67 S HIGLEY RD STE 103-208
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-1166
Country	:	US
Telephone Number	:	480-868-8697
Fax Number	:	906-374-3197

Provider Business Practice Location Address
First Line	:	2301 E LONE CACTUS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5507
Country	:	US
Telephone Number	:	602-900-5557
Fax Number	:	602-374-3197

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	CASSANDRA FORTSON
Credential	:
Telephone Number	:	480-868-8697

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/04/2026

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