Provider Demographics
NPI:1760054340
Name:YADENO CLEAN AND SOBER
Entity Type:Organization
Organization Name:YADENO CLEAN AND SOBER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASHUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-214-9980
Mailing Address - Street 1:2942 N 24TH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7850
Mailing Address - Country:US
Mailing Address - Phone:623-322-0730
Mailing Address - Fax:623-374-4592
Practice Address - Street 1:2942 N 24TH ST STE 211
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7850
Practice Address - Country:US
Practice Address - Phone:623-322-0730
Practice Address - Fax:623-374-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health