Healthcare Provider Details

I. General information

NPI: 1144376989
Provider Name (Legal Business Name): NEW HOPE CAROLINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7895 FOXCROFT LN
CHARLOTTE NC
28213-3878
US

IV. Provider business mailing address

7895 FOXCROFT LN
CHARLOTTE NC
28213-3878
US

V. Phone/Fax

Practice location:
  • Phone: 704-455-6433
  • Fax:
Mailing address:
  • Phone: 704-455-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number3106
License Number StateSC

VIII. Authorized Official

Name: MRS. BRENDA LEE CUPP
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 803-328-9300