Healthcare Provider Details

I. General information

NPI: 1912476482
Provider Name (Legal Business Name): GBC HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 SOUTH 1ST STREET
MONROE LA
71201
US

IV. Provider business mailing address

211 N 3RD ST
MONROE LA
71201-6731
US

V. Phone/Fax

Practice location:
  • Phone: 318-396-6300
  • Fax: 318-397-9271
Mailing address:
  • Phone: 318-396-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TED CALLOWAY
Title or Position: CFO
Credential:
Phone: 318-396-6300