Organization
RHR E COVINA OPERATOR LLC
Active
Other names
Restored Hope Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERSON OLSON (CEO/ADMINISTRATOR)
(602) 616-0266
Entity
Organization
Contact information
Practice address
11354 E COVINA ST, MESA, AZ 85207-1713
(602) 616-0266
Mailing address
11354 E COVINA ST, MESA, AZ 85207-1713
(602) 616-0266
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03D2310944
CLIA
AZ
01
—
BH10304
ARIZONA DEPARTMENT OF HEALTH SERVICES
AZ
Enumeration date
11/04/2024
Last updated
11/04/2024
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