Healthcare Provider Details

I. General information

NPI: 1548781693
Provider Name (Legal Business Name): GREATER NEW HOPE FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 08/23/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NW EASTMAN PKIWY STE. 175
GRESHAM OR
97030
US

IV. Provider business mailing address

PO BOX 30779
PORTLAND OR
97294-3779
US

V. Phone/Fax

Practice location:
  • Phone: 813-417-4013
  • Fax:
Mailing address:
  • Phone: 813-417-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LINDA ELLERBY
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 813-417-4013