Provider Demographics
NPI:1619299054
Name:HOUSE OF HOPE
Entity Type:Organization
Organization Name:HOUSE OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSIN
Authorized Official - Suffix:
Authorized Official - Credentials:ME
Authorized Official - Phone:602-770-3634
Mailing Address - Street 1:5814 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3177
Mailing Address - Country:US
Mailing Address - Phone:602-770-3634
Mailing Address - Fax:
Practice Address - Street 1:5814 S 11TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-3177
Practice Address - Country:US
Practice Address - Phone:602-770-3634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3487322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children