Healthcare Provider Details

I. General information

NPI: 1669269429
Provider Name (Legal Business Name): HOPE GREAT WATER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 KAYLA CT
NEWBURGH NY
12550-8644
US

IV. Provider business mailing address

PO BOX 76
SLATE HILL NY
10973-0076
US

V. Phone/Fax

Practice location:
  • Phone: 917-397-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCIS DAVIS
Title or Position: OWNER
Credential: PSYD
Phone: 763-226-5792