Healthcare Provider Details

I. General information

NPI: 1568602340
Provider Name (Legal Business Name): LUCA'S HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 04/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7947 STILLWATER DR
SHERRILLS FORD NC
28673-8325
US

IV. Provider business mailing address

7947 STILLWATER DR
SHERRILLS FORD NC
28673-8325
US

V. Phone/Fax

Practice location:
  • Phone: 828-478-2012
  • Fax:
Mailing address:
  • Phone: 828-228-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number018088
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALARIE BUTLER STANBACK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-228-7309