Healthcare Provider Details

I. General information

NPI: 1023229150
Provider Name (Legal Business Name): HOPE TOWN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BLAZEWOOD ST
RIVERSIDE CA
92507-5909
US

IV. Provider business mailing address

PO BOX 51993
RIVERSIDE CA
92517-2993
US

V. Phone/Fax

Practice location:
  • Phone: 951-377-1087
  • Fax: 951-683-3323
Mailing address:
  • Phone: 951-377-1087
  • Fax: 951-683-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: STACY A. IVERY
Title or Position: FOUNDER, EXECUTIVE DIRECTOR
Credential: L.C.S.W.
Phone: 951-377-1087