MEDICARE: HELPING HEARTS RESIDENTIAL FACILITIES I, 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	320800000X	Mental Illness Community Based Residential Treatment Facility	BH4745	AZ

General Provider Information

NPI Number	:	1336512003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELPING HEARTS RESIDENTIAL FACILITIES I, LLC

Provider Business Mailing Address
First Line	:	1500 E THOMAS RD
Second Line	:	SUITE 104
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5708
Country	:	US
Telephone Number	:	602-622-1290
Fax Number	:	602-926-1491

Provider Business Practice Location Address
First Line	:	4428 N 57TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1851
Country	:	US
Telephone Number	:	602-622-1290
Fax Number	:	602-926-8036

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. YNEZ CHRISTINE CROSS
Credential	:	MBA
Telephone Number	:	602-622-1290

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	10/06/2022

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