Healthcare Provider Details

I. General information

NPI: 1932254042
Provider Name (Legal Business Name): PATH OF HOPE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E CENTER STREET EXT
LEXINGTON NC
27292-1308
US

IV. Provider business mailing address

1675 E CENTER STREET EXT
LEXINGTON NC
27292-1308
US

V. Phone/Fax

Practice location:
  • Phone: 336-248-8914
  • Fax: 336-248-2138
Mailing address:
  • Phone: 336-248-8914
  • Fax: 336-248-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-029-006
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-029-007
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMHL-029-114
License Number StateNC

VIII. Authorized Official

Name: ANGIE BANTHER
Title or Position: EXECUTIVE DIRECTOR
Credential: MHDL, LCAS, CCS
Phone: 336-248-8914