=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356067169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE HOUSE OF HOPE II LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2022
-----------------------------------------------------
Last Update Date | 11/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1709 CLIFF RIDGE CT # A
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-9161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-386-8776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1709 CLIFF RIDGE CT # A
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-9161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-386-8776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RACHEL GRACE LAWRENCE
-----------------------------------------------------
Credential | CPSS
-----------------------------------------------------
Telephone | 706-386-8776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0800X
-----------------------------------------------------
Taxonomy Name | Recovery Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------