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General NPI Number Information
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NPI Number | 1235461773
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Entity Type | Organization
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Legal Business Name | H.O.P.E.
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Dates
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Enumeration Date | 02/09/2010
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 11712 VANDOREN LN
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City | FOUNTAIN
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State | FL
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Zip | 32438-5262
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Country | US
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Telephone | 850-722-6117
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Fax | 850-722-8712
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Provider Business Mailing Address
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Address Line | 11712 VANDOREN LN
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City | FOUNTAIN
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State | FL
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Zip | 32438-5262
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Country | US
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Telephone | 850-722-6117
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Fax | 850-722-8712
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. LARRY MARLIN KIRKLAND
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Credential | M.S., L.M.H.C.
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Telephone | 850-643-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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