Healthcare Provider Details

I. General information

NPI: 1558829283
Provider Name (Legal Business Name): HOPE RECOVERY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5260 MANHATTAN RD
JACKSON MS
39206-4258
US

IV. Provider business mailing address

5260 MANHATTAN RD
JACKSON MS
39206-4258
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 601-519-1731
  • Fax: 601-982-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORITA CAROL LEE
Title or Position: ADMIN
Credential: NURSE
Phone: 601-519-1731