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General NPI Number Information
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NPI Number | 1376689117
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Entity Type | Organization
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Legal Business Name | KEEP HOPE ALIVE, LLC.
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 3219 LANDMARK ST SUITE 6
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City | GREENVILLE
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State | NC
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Zip | 27834-7688
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Country | US
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Telephone | 252-353-8003
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30557
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City | GREENVILLE
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State | NC
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Zip | 27833-0557
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Country | US
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Telephone | 252-353-8003
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Fax | 252-353-9912
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MONICA D. WALLACE
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Credential |
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Telephone | 252-353-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-074-140
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL-074-139
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License Number State | NC
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