Provider Demographics
NPI:1083301048
Name:HOPE INTEGRATED CLINIC
Entity Type:Organization
Organization Name:HOPE INTEGRATED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIFT
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-306-1423
Mailing Address - Street 1:5220 E FAIRY DUSTER DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-5140
Mailing Address - Country:US
Mailing Address - Phone:480-306-1423
Mailing Address - Fax:
Practice Address - Street 1:911 W GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5308
Practice Address - Country:US
Practice Address - Phone:480-306-1423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health