Healthcare Provider Details

I. General information

NPI: 1497495972
Provider Name (Legal Business Name): HOPE REINS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N 1680 E STE I1
ST GEORGE UT
84790-2586
US

IV. Provider business mailing address

PO BOX 461294
LEEDS UT
84746-1294
US

V. Phone/Fax

Practice location:
  • Phone: 435-291-7258
  • Fax: 833-457-1704
Mailing address:
  • Phone: 435-291-7258
  • Fax: 833-457-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1154512283
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: MRS. AUBREE SULLIVAN
Title or Position: OWNER
Credential: LCSW
Phone: 435-291-7258