Provider Demographics
NPI:1972820371
Name:ANGELS OF HOPE BEHAVIORAL HEALTH RESIDENTIAL AGENCY
Entity Type:Organization
Organization Name:ANGELS OF HOPE BEHAVIORAL HEALTH RESIDENTIAL AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-628-4614
Mailing Address - Street 1:483 W GASCON RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5467
Mailing Address - Country:US
Mailing Address - Phone:480-628-4614
Mailing Address - Fax:480-699-9761
Practice Address - Street 1:483 W GASCON RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143-5467
Practice Address - Country:US
Practice Address - Phone:480-628-4614
Practice Address - Fax:480-699-9761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3556320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities