Healthcare Provider Details

I. General information

NPI: 1811448822
Provider Name (Legal Business Name): HOPE TREATMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SW FLAGLER AVE
STUART FL
34994-2148
US

IV. Provider business mailing address

PO BOX 1795
PALM CITY FL
34991-6795
US

V. Phone/Fax

Practice location:
  • Phone: 770-826-5431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT2766
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMT2766
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberMT2766
License Number StateFL

VIII. Authorized Official

Name: MR. CHAVOITA LESANE
Title or Position: CEO
Credential:
Phone: 770-826-5431