Provider Demographics
NPI:1366085052
Name:THE HAMPTON HOUSE LLC
Entity type:Organization
Organization Name:THE HAMPTON HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-320-1166
Mailing Address - Street 1:3638 W DENTON LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-2308
Mailing Address - Country:US
Mailing Address - Phone:602-320-1166
Mailing Address - Fax:
Practice Address - Street 1:5932 W MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-2122
Practice Address - Country:US
Practice Address - Phone:602-320-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HAMPTON HOUSE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health