Healthcare Provider Details

I. General information

NPI: 1114893021
Provider Name (Legal Business Name): MISSION OF HOPE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2963 BLUE JACKET CT
LIMA OH
45806-1464
US

IV. Provider business mailing address

2963 BLUE JACKET CT
LIMA OH
45806-1464
US

V. Phone/Fax

Practice location:
  • Phone: 419-581-9138
  • Fax:
Mailing address:
  • Phone: 419-581-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICAH MOORE
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 419-581-9138