Healthcare Provider Details

I. General information

NPI: 1124394499
Provider Name (Legal Business Name): HOPE IN THE MOUNTAINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TRIMBLE CHAPEL SQ
PRESTONSBURG KY
41653-8462
US

IV. Provider business mailing address

P.O. BOX 730
PAINTSVILLE KY
41240
US

V. Phone/Fax

Practice location:
  • Phone: 606-874-0240
  • Fax: 606-874-8666
Mailing address:
  • Phone: 606-874-0240
  • Fax: 606-874-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number810255
License Number StateKY

VIII. Authorized Official

Name: MRS. ROSANNA RENEE MCCOY
Title or Position: DIRECTOR
Credential: M.ED., NCC, CADC, RN
Phone: 606-874-0240