Healthcare Provider Details

I. General information

NPI: 1295934123
Provider Name (Legal Business Name): HOPE HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N ANAHEIM BLVD
ANAHEIM CA
92805-2652
US

IV. Provider business mailing address

707 N ANAHEIM BLVD
ANAHEIM CA
92805-2652
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-6090
  • Fax: 714-776-8650
Mailing address:
  • Phone: 714-776-6090
  • Fax: 714-776-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberIMF53138
License Number StateCA

VIII. Authorized Official

Name: MS. HOLLY KAY PETERS
Title or Position: THERAPIST
Credential:
Phone: 714-776-6030