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General NPI Number Information
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NPI Number | 1235632969
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Entity Type | Organization
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Legal Business Name | COMMUNITY HOPE HOME CARE
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 3140 S LAKE DR STE 4
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1411
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Country | US
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Telephone | 606-886-8551
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Fax |
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Provider Business Mailing Address
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Address Line | 3140 S LAKE DR STE 4
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1411
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Country | US
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Telephone | 606-886-8551
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Fax | 606-886-8551
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GARRETT BOUSE
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Credential |
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Telephone | 606-791-2916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 500283
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License Number State | KY
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