Healthcare Provider Details

I. General information

NPI: 1639847148
Provider Name (Legal Business Name): HOPE OUTREACH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 FARRINGTON ST
ROSEVILLE MN
55113-2405
US

IV. Provider business mailing address

2816 FARRINGTON ST
ROSEVILLE MN
55113-2405
US

V. Phone/Fax

Practice location:
  • Phone: 651-424-2386
  • Fax: 651-756-1873
Mailing address:
  • Phone: 651-424-2386
  • Fax: 651-756-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MAHOGANY NICOLE DAVIS
Title or Position: CEO
Credential:
Phone: 651-424-2386