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General NPI Number Information
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NPI Number | 1073294229
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Entity Type | Organization
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Legal Business Name | GREEN LIGHT OF HOPE LLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 687 SAM HALEY RD
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City | DANVILLE
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State | VA
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Zip | 24541-7715
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Country | US
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Telephone | 434-441-0427
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 LOCKETT DR
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City | DANVILLE
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State | VA
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Zip | 24541-4050
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Country | US
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Telephone | 434-441-0427
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELVIN MILLER
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Credential |
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Telephone | 434-441-0427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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