Healthcare Provider Details

I. General information

NPI: 1144161530
Provider Name (Legal Business Name): HOPE RESIDENTIAL SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W BROADWAY
SALT LAKE CITY UT
84101-2020
US

IV. Provider business mailing address

50 W BROADWAY
SALT LAKE CITY UT
84101-2020
US

V. Phone/Fax

Practice location:
  • Phone: 207-400-6495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SCHADRACK MUSHID
Title or Position: CEO
Credential:
Phone: 207-400-6491