Healthcare Provider Details

I. General information

NPI: 1609474824
Provider Name (Legal Business Name): HOPESPRING HOLISTIC HEALTH INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 OLD NORTH BERWICK RD
ALFRED ME
04002-3731
US

IV. Provider business mailing address

PO BOX 976
KENNEBUNK ME
04043-0976
US

V. Phone/Fax

Practice location:
  • Phone: 207-850-9011
  • Fax:
Mailing address:
  • Phone: 207-850-9011
  • 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 Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JODY E LEVY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-850-9011