Provider Demographics
NPI:1245803857
Name:HOPE GROUP CLINICAL
Entity Type:Organization
Organization Name:HOPE GROUP CLINICAL
Other - Org Name:HOPE GROUP LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CITADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UMALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-610-6981
Mailing Address - Street 1:4530 E MUIRWOOD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7693
Mailing Address - Country:US
Mailing Address - Phone:480-610-6981
Mailing Address - Fax:
Practice Address - Street 1:4530 E MUIRWOOD DR STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7693
Practice Address - Country:US
Practice Address - Phone:480-610-6981
Practice Address - Fax:480-898-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ926675Medicaid