1851786222 NPI number — HOPE LIVES - VIVE LA ESPERANZA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851786222 NPI number — HOPE LIVES - VIVE LA ESPERANZA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPE LIVES - VIVE LA ESPERANZA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851786222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 W 1ST ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85122-4449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-672-2694
Provider Business Mailing Address Fax Number:
602-388-1567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1016 E BUCKEYE RD
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85034-4041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-672-2694
Provider Business Practice Location Address Fax Number:
602-388-1567
Provider Enumeration Date:
04/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
MARC
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-672-2694

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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