Provider Demographics
NPI:1457016552
Name:HOPE CANYON RECOVERY, INC
Entity Type:Organization
Organization Name:HOPE CANYON RECOVERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-633-6130
Mailing Address - Street 1:1515 NW 167TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5106
Mailing Address - Country:US
Mailing Address - Phone:855-297-0980
Mailing Address - Fax:305-930-7437
Practice Address - Street 1:100 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7000
Practice Address - Country:US
Practice Address - Phone:619-343-2395
Practice Address - Fax:305-930-7437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE CANYON RECOVERY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA370001BPOtherDEPARTMENT OF HEALTHCARE SERVICES