Healthcare Provider Details

I. General information

NPI: 1265887277
Provider Name (Legal Business Name): RESOURCE RAE OF HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 39TH ST FLOOR 3
BROOKLYN NY
11232-2909
US

IV. Provider business mailing address

449 39TH ST FLOOR 3
BROOKLYN NY
11232-2909
US

V. Phone/Fax

Practice location:
  • Phone: 929-295-2093
  • Fax:
Mailing address:
  • Phone: 929-295-2093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DONNA MAE DEPOLA
Title or Position: PRESIDENT
Credential: CASAC
Phone: 929-295-2093