Healthcare Provider Details

I. General information

NPI: 1902164684
Provider Name (Legal Business Name): CHILDREN'S HOPE RESIDENTIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 CANYON LAKE DR
LUBBOCK TX
79415-2000
US

IV. Provider business mailing address

500 WEST AVE
LEVELLAND TX
79336-3341
US

V. Phone/Fax

Practice location:
  • Phone: 806-762-5782
  • Fax: 806-762-0838
Mailing address:
  • Phone: 806-897-9735
  • Fax: 806-568-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1423046
License Number StateTX

VIII. Authorized Official

Name: MR. JAMES ALDRICH
Title or Position: CEO
Credential:
Phone: 806-897-9735