Healthcare Provider Details

I. General information

NPI: 1184979908
Provider Name (Legal Business Name): HOPE AND A FUTURE MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 MAYPORT RD.
ATLANTIC BEACH FL
32233
US

IV. Provider business mailing address

14149 WASHBURN CT.
JACKSONVILLE FL
32250
US

V. Phone/Fax

Practice location:
  • Phone: 904-339-5937
  • Fax:
Mailing address:
  • Phone: 904-339-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberN10000009242
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberN10000009242
License Number StateFL

VIII. Authorized Official

Name: MS. CARISSA LYNETTE DORE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 904-339-5937