Healthcare Provider Details

I. General information

NPI: 1801932892
Provider Name (Legal Business Name): HOPE INTHE CAROLINA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N. MAIN STREET SUITE 2
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: 910-916-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3418143
License Number StateNC

VIII. Authorized Official

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