Healthcare Provider Details

I. General information

NPI: 1578646469
Provider Name (Legal Business Name): HOPE HOUSE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 714 N. ANAHEIM BLVD.
ANAHEIM CA
92805-2651
US

IV. Provider business mailing address

710 N. ANAHEIM BLVD.
ANAHEIM CA
92805-2651
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-7490
  • Fax: 657-276-9041
Mailing address:
  • Phone: 714-776-7490
  • Fax: 657-276-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300034AN
License Number StateCA

VIII. Authorized Official

Name: CATHY LYNN STILLS
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 714-776-7490