Healthcare Provider Details

I. General information

NPI: 1346758422
Provider Name (Legal Business Name): HOPE HOME CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S POPLAR ST STE 4
HAZLETON PA
18201-7707
US

IV. Provider business mailing address

601 S POPLAR ST STE 4
HAZLETON PA
18201-7707
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-2200
  • Fax: 570-455-2201
Mailing address:
  • Phone: 570-455-2400
  • Fax: 570-455-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number36263601
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier36263601
Identifier TypeOTHER
Identifier State
Identifier IssuerFACILITY ID

VIII. Authorized Official

Name: ALTAGRACIA SANTANA GOMEZ
Title or Position: VP
Credential: CNA
Phone: 570-455-2400