Provider Demographics
NPI:1922733641
Name:COMMUNITY HOPE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:COMMUNITY HOPE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DAUD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLEOSHO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:520-431-8744
Mailing Address - Street 1:414 W KNIGHT LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1369
Mailing Address - Country:US
Mailing Address - Phone:623-225-1240
Mailing Address - Fax:
Practice Address - Street 1:14001 N 7TH ST STE A101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4382
Practice Address - Country:US
Practice Address - Phone:520-431-8744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC11822OtherAZDHS-MEDICAL FACILITIES LICENSING