Healthcare Provider Details

I. General information

NPI: 1568025658
Provider Name (Legal Business Name): HOPESTONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CUSHMAN RD
WINSLOW ME
04901-7212
US

IV. Provider business mailing address

49 CUSHMAN RD
WINSLOW ME
04901-7212
US

V. Phone/Fax

Practice location:
  • Phone: 207-877-5966
  • Fax: 207-616-0442
Mailing address:
  • Phone: 207-877-5966
  • Fax: 207-616-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ASHLEIGH OVERLOCK
Title or Position: OWNER
Credential:
Phone: 207-877-5966