Healthcare Provider Details

I. General information

NPI: 1245672898
Provider Name (Legal Business Name): THE HOPE CENTER FOR LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 US HIGHWAY 301 S
RIVERVIEW FL
33578-3850
US

IV. Provider business mailing address

PO BOX 648
VALRICO FL
33595-0648
US

V. Phone/Fax

Practice location:
  • Phone: 813-671-4673
  • Fax:
Mailing address:
  • Phone: 813-671-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number13-29-AD-5850-01
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number13-29-AD-5850-01
License Number StateFL

VIII. Authorized Official

Name: REBA HALEY
Title or Position: CHEIF EXECUTIVE DIRECTOR
Credential: PHD
Phone: 813-716-3996