MEDICARE: HOPE AND RESTORATION PATHWAYS, INC.

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	251S00000X	Community/Behavioral Health Agency	A8986	NC

General Provider Information

NPI Number	:	1326450859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE AND RESTORATION PATHWAYS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1775
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27528-1775
Country	:	US
Telephone Number	:	919-439-6474
Fax Number	:	919-550-0337

Provider Business Practice Location Address
First Line	:	501 GATEWAY DR
Second Line	:	SUITE101G
City	:	CLAYTON
State	:	NC
Zip	:	27520-2277
Country	:	US
Telephone Number	:	919-439-6474
Fax Number	:	919-550-0337

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LORA S. WILLIAMS
Credential	:	LCSW, CMSW
Telephone Number	:	919-439-6474

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/02/2014

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