Healthcare Provider Details

I. General information

NPI: 1184495954
Provider Name (Legal Business Name): HOPE CENTER CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S ORCHARD ST STE 102
BOISE ID
83705-1961
US

IV. Provider business mailing address

1111 S ORCHARD ST STE 102
BOISE ID
83705-1961
US

V. Phone/Fax

Practice location:
  • Phone: 208-919-4692
  • Fax: 410-824-1482
Mailing address:
  • Phone: 208-919-4692
  • Fax: 410-824-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARCEE JONES
Title or Position: CREDENTIALING ADMINISTRATOR
Credential: NCMA
Phone: 410-824-1480