Organization
TERRA MEDICAL OF ARIZONA LLC
Active
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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