Healthcare Provider Details

I. General information

NPI: 1033263215
Provider Name (Legal Business Name): HOPE IN THE CAROLINA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 NORTH MAIN STREET SUITE 2
KENANSVILLE NC
28349-9019
US

IV. Provider business mailing address

PO BOX 1576
ROSEBORO NC
28382-1576
US

V. Phone/Fax

Practice location:
  • Phone: 910-916-3929
  • Fax:
Mailing address:
  • Phone: 910-916-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number89127KP
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number8301208B
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number8301208B
License Number StateNC

VIII. Authorized Official

Name: MR. SHELTON JAMES PARKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-916-3929