Healthcare Provider Details

I. General information

NPI: 1083003354
Provider Name (Legal Business Name): HOPE WOA NONPROFIT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W HAMLET AVE
HAMLET NC
28345-2623
US

IV. Provider business mailing address

509 W HAMLET AVE
HAMLET NC
28345-2623
US

V. Phone/Fax

Practice location:
  • Phone: 704-288-6945
  • Fax:
Mailing address:
  • Phone: 704-288-6945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. TAHIYYA LEE
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 704-288-6945