Provider Demographics
NPI:1245762087
Name:HEARTH HOMES
Entity Type:Organization
Organization Name:HEARTH HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:YOLANDE
Authorized Official - Last Name:HECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:BSC/BHT
Authorized Official - Phone:602-218-8860
Mailing Address - Street 1:4435 E PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2822
Mailing Address - Country:US
Mailing Address - Phone:602-218-8860
Mailing Address - Fax:602-218-8860
Practice Address - Street 1:4435 E PHELPS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2822
Practice Address - Country:US
Practice Address - Phone:602-218-8860
Practice Address - Fax:602-218-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5132251S00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5132Medicaid