Healthcare Provider Details

I. General information

NPI: 1548693203
Provider Name (Legal Business Name): HOPE DEVELOPMENTAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S MAIN ST STE B
ROSWELL NM
88203-5614
US

IV. Provider business mailing address

2603 W 25TH ST
ROSWELL NM
88201-8878
US

V. Phone/Fax

Practice location:
  • Phone: 575-910-1333
  • Fax: 575-208-0214
Mailing address:
  • Phone: 575-910-1333
  • Fax: 575-208-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID RODRIGUEZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 575-910-1333