Provider Demographics
NPI:1467106609
Name:HOPE LIGHT CARE HOMES , LLC
Entity Type:Organization
Organization Name:HOPE LIGHT CARE HOMES , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NDAYIRAGIJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-278-2047
Mailing Address - Street 1:9963 W MONTEROSA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2510
Mailing Address - Country:US
Mailing Address - Phone:148-027-8204
Mailing Address - Fax:
Practice Address - Street 1:15020 N FLAMENCO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4862
Practice Address - Country:US
Practice Address - Phone:480-278-2047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness