Provider Demographics
NPI:1821358755
Name:VISIONS OF HOPE ARIZONA, INC.
Entity Type:Organization
Organization Name:VISIONS OF HOPE ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MPH
Authorized Official - Phone:602-404-1555
Mailing Address - Street 1:601 W HATCHER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-3594
Mailing Address - Country:US
Mailing Address - Phone:602-404-1555
Mailing Address - Fax:602-867-2435
Practice Address - Street 1:601 W HATCHER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-3594
Practice Address - Country:US
Practice Address - Phone:602-404-1555
Practice Address - Fax:602-867-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3998251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management