Provider Demographics
NPI:1891240107
Name:LIVING HOPE COMMUNITY CARE CENTERS LLC
Entity Type:Organization
Organization Name:LIVING HOPE COMMUNITY CARE CENTERS LLC
Other - Org Name:ELIZABETH HOUSE, LLC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-712-6170
Mailing Address - Street 1:PO BOX 9598
Mailing Address - Street 2:
Mailing Address - City:CHANDLER HEIGHTS
Mailing Address - State:AZ
Mailing Address - Zip Code:85127-9598
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3026 E SAN MANUEL RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-4536
Practice Address - Country:US
Practice Address - Phone:480-712-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS DEVELOPMENT GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-17
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility