Provider Demographics
NPI:1750498739
Name:HOUSE OF HOPE
Entity Type:Organization
Organization Name:HOUSE OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA LSAC
Authorized Official - Phone:801-487-3276
Mailing Address - Street 1:857 E 200 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2334
Mailing Address - Country:US
Mailing Address - Phone:801-487-3276
Mailing Address - Fax:801-467-3725
Practice Address - Street 1:1726 BUCKLEY LN
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5031
Practice Address - Country:US
Practice Address - Phone:801-373-6562
Practice Address - Fax:801-375-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11450324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========002Medicaid