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General NPI Number Information
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NPI Number | 1063946796
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Entity Type | Organization
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Legal Business Name | HOPE HEALTH AND HEALING CLINIC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 1375 OLD HICKORY BLVD
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City | NASHVILLE
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State | TN
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Zip | 37207-1423
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Country | US
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Telephone | 615-732-0415
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Fax | 615-577-3772
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Provider Business Mailing Address
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Address Line | 1375 OLD HICKORY BLVD
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City | NASHVILLE
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State | TN
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Zip | 37207-1423
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Country | US
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Telephone | 615-732-0415
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Fax | 615-577-3772
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. FREDA GARDNER FULLER
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Credential | MSN
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Telephone | 615-732-0415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 000830915
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License Number State | TN
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