Healthcare Provider Details

I. General information

NPI: 1760293856
Provider Name (Legal Business Name): HOPE AHEAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W DETWEILLER DR STE 810
PEORIA IL
61615-2140
US

IV. Provider business mailing address

2522 W STONEHENGE CT
PEORIA IL
61615-7481
US

V. Phone/Fax

Practice location:
  • Phone: 309-264-9517
  • Fax:
Mailing address:
  • Phone: 309-264-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SANDRA CROSS
Title or Position: OWNER/CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 309-264-9517