=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053287375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLA OF HOPE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2025
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11725 NE COUNTY ROAD 793
-----------------------------------------------------
City | RAIFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32083-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-494-4246
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11725 NE COUNTY ROAD 793
-----------------------------------------------------
City | RAIFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32083-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TAMARA GRIFFIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-494-4246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------