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General NPI Number Information
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NPI Number | 1073097531
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Entity Type | Organization
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Legal Business Name | MINISTRY FOR HOPE, INC. MONTFORT THERAPEUTIC RESIDENCE
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 100 STONYHILL ROAD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-928-5223
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Fax | 631-928-4466
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Provider Business Mailing Address
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Address Line | PO BOX 358
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-928-5223
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Fax | 631-928-4466
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. CHARLES GERACE
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Credential | LCSW
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Telephone | 631-928-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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