Provider Demographics
NPI:1699369538
Name:HOFUNITY BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:HOFUNITY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TLAHJONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:602-799-2757
Mailing Address - Street 1:7141 W CARTER RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7059
Mailing Address - Country:US
Mailing Address - Phone:602-799-2757
Mailing Address - Fax:480-525-7974
Practice Address - Street 1:4714 W ST KATERI DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-8200
Practice Address - Country:US
Practice Address - Phone:602-799-2757
Practice Address - Fax:480-525-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH6634OtherAZ DEPT OF HEALTH
AZBH6635OtherAZ DEPT OF HEALTH