MEDICARE: HARBOR OF HOPE YOUTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1144173394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR OF HOPE YOUTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	536 KEYSTONE TER
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-8323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 KEYSTONE TER
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-8323
Country	:	US
Telephone Number	:	407-406-1603
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JIBRIA STAFFORD
Credential	:
Telephone Number	:	407-406-1603

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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