Provider Demographics
NPI:1063837243
Name:HOPE BEHAVIORAL HEALTH RESIDENTIAL CARE
Entity Type:Organization
Organization Name:HOPE BEHAVIORAL HEALTH RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ODETOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-925-8606
Mailing Address - Street 1:16181 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2898
Mailing Address - Country:US
Mailing Address - Phone:623-925-8606
Mailing Address - Fax:623-925-8606
Practice Address - Street 1:22981 W HOPI ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-8614
Practice Address - Country:US
Practice Address - Phone:623-547-2243
Practice Address - Fax:623-547-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4441103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty