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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH5985	OTHER	AZ	STATE OF ARIZONA DEPARTMENT OF HEALTH SERVICES

General Provider Information

NPI Number	:	1750928446
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 STE 104
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5748
Country	:	US
Telephone Number	:	602-622-1290
Fax Number	:

Provider Business Practice Location Address
First Line	:	3834 W LANE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6475
Country	:	US
Telephone Number	:	602-975-6152
Fax Number	:	602-926-8036

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YNEZ C CROSS
Credential	:
Telephone Number	:	602-622-1290

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	01/16/2020

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