Organization
TERRA MEDICAL OF ARIZONA LLC
Active
Other names
House of Hope Behavioral Health LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL APPLETON (MANAGER)
(602) 618-3756
Entity
Organization
Contact information
Practice address
1297 E AVENIDA KINO, CASA GRANDE, AZ 85122-1011
(520) 709-1586
(602) 235-0405
Mailing address
65 N POTTEBAUM RD, CASA GRANDE, AZ 85122-5326
(602) 618-3756
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH10111
FACILITY LICENSE
AZ
01
—
BH10112
FACILITY LICENSE
AZ
01
—
BH6760
FACILITY LICENSE
AZ
Enumeration date
06/20/2024
Last updated
06/20/2024
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