Healthcare Provider Details

I. General information

NPI: 1104007723
Provider Name (Legal Business Name): HOUSE OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 SHEVE RD.
ROCKY MOUNT NC
27801
US

IV. Provider business mailing address

2416 SHEVE RD
ROCKY MOUNT NC
27801
US

V. Phone/Fax

Practice location:
  • Phone: 252-442-7146
  • Fax:
Mailing address:
  • Phone: 252-442-7146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMHL033-050
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMHL033-050
License Number StateNC

VIII. Authorized Official

Name: MR. LEWIS EARL WILLIAMS I
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-442-7146