Provider Demographics
NPI:1912561176
Name:HOPE BEHAVIORAL HEALTH RESIDENTIAL CARE
Entity Type:Organization
Organization Name:HOPE BEHAVIORAL HEALTH RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ODETOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-925-8606
Mailing Address - Street 1:17547 W DESERT BLOOM ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4713
Mailing Address - Country:US
Mailing Address - Phone:602-820-2251
Mailing Address - Fax:623-925-2076
Practice Address - Street 1:17547 W DESERT BLOOM ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4713
Practice Address - Country:US
Practice Address - Phone:602-820-2225
Practice Address - Fax:623-925-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances