MEDICARE: NEW HOPE BEHAVIORAL RESIDENTIAL 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

General Provider Information

NPI Number	:	1932812419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HOPE BEHAVIORAL RESIDENTIAL LLC

Provider Business Mailing Address
First Line	:	12514 W WILLOW AVE
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-6020
Country	:	US
Telephone Number	:	623-600-8683
Fax Number	:	623-600-8683

Provider Business Practice Location Address
First Line	:	12514 W WILLOW AVE
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-6020
Country	:	US
Telephone Number	:	623-600-8683
Fax Number	:	623-600-8683

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JEAN REMY NAHIMANA
Credential	:
Telephone Number	:	602-545-6580

Provider Enumeration Date	:	12/30/2022
Last Update Date	:	12/30/2022

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