Healthcare Provider Details

I. General information

NPI: 1134047954
Provider Name (Legal Business Name): COMMUNITY HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 SHOUP AVE W STE C338
TWIN FALLS ID
83301-5027
US

IV. Provider business mailing address

414 SHOUP AVE W STE C338
TWIN FALLS ID
83301-5027
US

V. Phone/Fax

Practice location:
  • Phone: 623-666-1418
  • Fax:
Mailing address:
  • Phone: 623-666-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MARCEE JONES
Title or Position: CREDENTIALING DIRECTOR
Credential: NCMA/ASCI
Phone: 410-824-1480