MEDICARE: ECHOES OF HOPE

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	BH-2729	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	147037	OTHER	AZ	AHCCCS PROVIDER NUMBER

General Provider Information

NPI Number	:	1679696009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECHOES OF HOPE

Provider Business Mailing Address
First Line	:	7207 S 38TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6103
Country	:	US
Telephone Number	:	602-682-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	7207 S 38TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6103
Country	:	US
Telephone Number	:	602-682-7222
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JARETT W LOGGINS
Credential	:
Telephone Number	:	602-682-7222

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/22/2020

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Directions to “ECHOES OF HOPE ” Practice Location

Language	Start Address	Practice Location

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