Healthcare Provider Details

I. General information

NPI: 1730813353
Provider Name (Legal Business Name): HOPE FOR LIVING HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9906 STALL AVE
LANHAM MD
20706-2379
US

IV. Provider business mailing address

9906 STALL AVE
LANHAM MD
20706-2379
US

V. Phone/Fax

Practice location:
  • Phone: 513-371-2802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIEUDONNE METOMBE
Title or Position: DIRECTOR
Credential:
Phone: 513-371-2802