Provider Demographics
NPI:1629436647
Name:HOUSE OF HOPE ELOY
Entity Type:Organization
Organization Name:HOUSE OF HOPE ELOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FOLASAYO
Authorized Official - Middle Name:IYABODE
Authorized Official - Last Name:OLADOKUN-DYBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-421-1157
Mailing Address - Street 1:115 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5201
Mailing Address - Country:US
Mailing Address - Phone:520-421-1157
Mailing Address - Fax:520-421-2877
Practice Address - Street 1:406 W 11TH ST
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131-1810
Practice Address - Country:US
Practice Address - Phone:520-421-1157
Practice Address - Fax:520-421-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4846320800000X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH4846OtherSTATE LICENCE