Healthcare Provider Details

I. General information

NPI: 1467987602
Provider Name (Legal Business Name): HOPE SPRINGS ETERNAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 S STATE ROAD 7 SUITE 15
MARGATE FL
33068-1973
US

IV. Provider business mailing address

441 S STATE ROAD 7 SUITE 15
MARGATE FL
33068-1973
US

V. Phone/Fax

Practice location:
  • Phone: 954-590-8352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAVID LAM
Title or Position: OWNER
Credential:
Phone: 954-590-8363