Provider Demographics
NPI:1750059572
Name:AMAZING HOPE BEHAVIORAL HOME 2
Entity Type:Organization
Organization Name:AMAZING HOPE BEHAVIORAL HOME 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BAAFI
Authorized Official - Last Name:OPUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-338-0607
Mailing Address - Street 1:1614 E VERNOA ST
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7869
Mailing Address - Country:US
Mailing Address - Phone:571-338-0607
Mailing Address - Fax:
Practice Address - Street 1:1614 E VERNOA ST
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7869
Practice Address - Country:US
Practice Address - Phone:571-338-0607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZING HOPE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health