Provider Demographics
NPI:1255164463
Name:HOPE LOVE AND CARE GROUP HOME LLC
Entity type:Organization
Organization Name:HOPE LOVE AND CARE GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:AYIYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-710-4171
Mailing Address - Street 1:13029 W AVALON DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6608 S 16TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5814
Practice Address - Country:US
Practice Address - Phone:602-710-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities