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General NPI Number Information
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NPI Number | 1275065302
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Entity Type | Organization
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Legal Business Name | HOPE COMMUNITY SUPPORT LLC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 104 WYLIE ST
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City | CHESTER
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State | SC
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Zip | 29706-1714
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Country | US
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Telephone | 803-601-9220
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WYLIE ST
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City | CHESTER
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State | SC
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Zip | 29706-1714
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Country | US
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Telephone | 803-601-9220
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LETISHAL JUANITA KELLY
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Credential |
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Telephone | 803-601-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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