Provider Demographics
NPI:1871136945
Name:OUR HOME OF UNITY LLC
Entity type:Organization
Organization Name:OUR HOME OF UNITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TLAHJONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BHT
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:503-891-0610
Mailing Address - Fax:
Practice Address - Street 1:8105 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-5420
Practice Address - Country:US
Practice Address - Phone:503-891-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BH5954
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-22
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ598608Medicaid
AZBH5738OtherAZ DEPT OF HEALTH
AZBH5904OtherAZ DEPT OF HEALTH
AZBH5550OtherAZ DEPT OF HEALTH
AZBH5731OtherAZ DEPT OF HEALTH
AZBH5954OtherAZ DEPT OF HEALTH
AZBH5953OtherAZ DEPT OF HEALTH