Provider Demographics
NPI: | 1437702883 |
---|---|
Name: | OUR HOME OF UNITY LLC |
Entity Type: | Organization |
Organization Name: | OUR HOME OF UNITY LLC |
Other - Org Name: | OUR HOME OF UNITY LLC 3 |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | TLAHJONTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOPSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OWNER |
Authorized Official - Phone: | 602-799-2757 |
Mailing Address - Street 1: | 7141 W CARTER RD |
Mailing Address - Street 2: | |
Mailing Address - City: | LAVEEN |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85339-7059 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-891-0610 |
Mailing Address - Fax: | 888-753-0530 |
Practice Address - Street 1: | 8325 W SUPERIOR AVE |
Practice Address - Street 2: | |
Practice Address - City: | TOLLESON |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85353-3694 |
Practice Address - Country: | US |
Practice Address - Phone: | 623-233-6382 |
Practice Address - Fax: | 888-753-0530 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | BH5738 |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-07-24 |
Last Update Date: | 2020-10-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 163WP0809X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 172A00000X | Other Service Providers | Driver | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | Group - Multi-Specialty | |
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 552878 | Medicaid | |
AZ | BH5738 | Other | AZ DEPT OF HEALTH |
AZ | BH5953 | Other | AZ DEPT OF HEALTH |
AZ | BH5954 | Other | AZ DEPT OF HEALTH |
AZ | BH5550 | Other | AZ DEPT OF HEALTH |
AZ | BH5904 | Other | AZ DEPT OF HEALTH |
AZ | BH5731 | Other | AZ DEPT OF HEALTH |