Healthcare Provider Details

I. General information

NPI: 1154049146
Provider Name (Legal Business Name): HOPE N WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 RUCKER AVE
EVERETT WA
98201-3931
US

IV. Provider business mailing address

PO BOX 121
ARLINGTON WA
98223-0121
US

V. Phone/Fax

Practice location:
  • Phone: 360-540-5104
  • Fax:
Mailing address:
  • Phone: 360-540-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JASMINE S. WALTS-DONAHUE
Title or Position: OPERATOR
Credential: CPC
Phone: 360-540-5104