Basic Information
| Provider Information | |||||||||
| NPI: | 1093306409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOINT HEALING OPERATIONS ALPHA HOUSE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 E VERNON AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8445461212 | ||||||||
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| Practice Location | |||||||||
| Address1: | 31 E VERNON AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8445461212 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2021 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDMAN | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8445461212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JOINT HEALING OPERATIONS | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3104A0630X | N | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.