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General NPI Number Information
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NPI Number | 1073206041
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Entity Type | Organization
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Legal Business Name | HOPE FOUNTAINS CARE, LLC
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 18 QUINCY ST
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City | CONCORD
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State | NH
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Zip | 03301-5341
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Country | US
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Telephone | 207-409-2088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4073
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City | CONCORD
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State | NH
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Zip | 03302-4073
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Country | US
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Telephone | 207-409-2088
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE DIRECTOR
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Name | CHARLES MAKOKO RUSHIMISHA
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Credential |
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Telephone | 207-409-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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