Provider Demographics
NPI:1215538111
Name:HOPE & HAVEN FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:HOPE & HAVEN FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHONIA
Authorized Official - Middle Name:SHASHERAH
Authorized Official - Last Name:PENNIX
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:773-661-8193
Mailing Address - Street 1:644 N COUNTRY CLUB DR STE C
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4983
Mailing Address - Country:US
Mailing Address - Phone:773-661-8193
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:3015 N SCOTTSDALE RD UNIT 4222
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7262
Practice Address - Country:US
Practice Address - Phone:773-661-8193
Practice Address - Fax:999-999-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ00000000Medicaid