Healthcare Provider Details

I. General information

NPI: 1922842566
Provider Name (Legal Business Name): DAVID'S HOPE HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 NATALIE DR
HAMPTON VA
23666-5567
US

IV. Provider business mailing address

19 NATALIE DR
HAMPTON VA
23666-5567
US

V. Phone/Fax

Practice location:
  • Phone: 757-608-1397
  • Fax:
Mailing address:
  • Phone: 757-608-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MATTIELOU GILLIAM
Title or Position: CEO
Credential:
Phone: 757-608-1397