Provider Demographics
NPI:1750928446
Name:HELPING HEARTS RESIDENTIAL FACILITIES I, LLC
Entity type:Organization
Organization Name:HELPING HEARTS RESIDENTIAL FACILITIES I, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YNEZ
Authorized Official - Middle Name:C
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-622-1290
Mailing Address - Street 1:1500 E THOMAS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5748
Mailing Address - Country:US
Mailing Address - Phone:602-622-1290
Mailing Address - Fax:
Practice Address - Street 1:3834 W LANE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6475
Practice Address - Country:US
Practice Address - Phone:602-975-6152
Practice Address - Fax:602-926-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5985OtherSTATE OF ARIZONA DEPARTMENT OF HEALTH SERVICES