MEDICARE: H.O.P.E THERAPEUTIC SERVICES, 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	C3524117	CA

General Provider Information

NPI Number	:	1891173944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H.O.P.E THERAPEUTIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	4811 CHIPPENDALE DR
Second Line	:	SUITE 601
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-2555
Country	:	US
Telephone Number	:	916-514-8030
Fax Number	:	916-514-8029

Provider Business Practice Location Address
First Line	:	4811 CHIPPENDALE DR
Second Line	:	SUITE 601
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-2555
Country	:	US
Telephone Number	:	916-514-8030
Fax Number	:	916-514-8029

Authorized Official
Title or Position	:	CO-DIRECTOR
Name	:	BETHANY A MARONEY-PETERSON
Credential	:	MA, LMFT
Telephone Number	:	916-514-8030

Provider Enumeration Date	:	05/09/2015
Last Update Date	:	05/09/2015

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