Healthcare Provider Details

I. General information

NPI: 1427375005
Provider Name (Legal Business Name): HOPE IN THE CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 NORTH MAIN STREET
KENANSVILLE NC
28349-9091
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number89127KP
License Number StateNC

VIII. Authorized Official

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