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General NPI Number Information
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NPI Number | 1295034197
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Entity Type | Organization
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Legal Business Name | MERCHANTS OF HOPE COMMUNITY MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 4610 CASTLEMAN DR
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City | AUSTIN
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State | TX
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Zip | 78725-1718
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Country | US
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Telephone | 512-276-7038
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 CAMERON RD STE 3-307
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City | AUSTIN
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State | TX
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Zip | 78754-3843
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Country | US
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Telephone | 512-947-2305
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Fax | 512-382-9458
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. PETER CHINA EJIRIKA
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Credential | CPA
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Telephone | 512-947-2305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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