Provider Demographics
NPI:1184240731
Name:EMBRACE HOPE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:EMBRACE HOPE BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDIDIONG
Authorized Official - Middle Name:
Authorized Official - Last Name:EFFIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-781-1444
Mailing Address - Street 1:7707 W KERBY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1677
Mailing Address - Country:US
Mailing Address - Phone:641-781-1444
Mailing Address - Fax:
Practice Address - Street 1:7707 W KERBY AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1677
Practice Address - Country:US
Practice Address - Phone:641-781-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities