Healthcare Provider Details

I. General information

NPI: 1356893630
Provider Name (Legal Business Name): HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CEMETERY RD
LEBANON KY
40033-1827
US

IV. Provider business mailing address

106 CEMETERY RD
LEBANON KY
40033-1827
US

V. Phone/Fax

Practice location:
  • Phone: 270-401-1104
  • Fax:
Mailing address:
  • Phone: 270-401-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPCPCC00223155
License Number StateKY

VIII. Authorized Official

Name: TAMMY LYNN MATTINGLY
Title or Position: OWNER
Credential: LPCC
Phone: 270-402-5601