MEDICARE: HOPE STREET, 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-041-719	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750421434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE STREET, LLC

Provider Business Mailing Address
First Line	:	2007 LYNN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6519
Country	:	US
Telephone Number	:	336-375-5985
Fax Number	:	336-375-0253

Provider Business Practice Location Address
First Line	:	2007 LYNN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6519
Country	:	US
Telephone Number	:	336-375-5985
Fax Number	:	336-375-0253

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MR. DENNIS WHITE
Credential	:
Telephone Number	:	336-375-5985

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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Directions to “HOPE STREET, LLC ” Practice Location

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