MEDICARE: LUCA'S HOPE

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	018088	NC
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1568602340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCA'S HOPE

Provider Business Mailing Address
First Line	:	7947 STILLWATER DR
Second Line	:
City	:	SHERRILLS FORD
State	:	NC
Zip	:	28673-8325
Country	:	US
Telephone Number	:	828-228-7309
Fax Number	:

Provider Business Practice Location Address
First Line	:	7947 STILLWATER DR
Second Line	:
City	:	SHERRILLS FORD
State	:	NC
Zip	:	28673-8325
Country	:	US
Telephone Number	:	828-478-2012
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. VALARIE BUTLER STANBACK
Credential	:
Telephone Number	:	828-228-7309

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	04/29/2018

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