Healthcare Provider Details

I. General information

NPI: 1477186252
Provider Name (Legal Business Name): OUR HANDS OF HOPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MORROW AVE
PINEVILLE NC
28134-6529
US

IV. Provider business mailing address

2939 SOUTHEASTERN RD
ROCK HILL SC
29730-8166
US

V. Phone/Fax

Practice location:
  • Phone: 803-804-0329
  • Fax: 980-321-0049
Mailing address:
  • Phone: 803-804-0329
  • Fax: 980-321-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JASON KEITH PETILLO
Title or Position: CEO
Credential:
Phone: 803-804-0329