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General NPI Number Information
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NPI Number | 1497524987
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Entity Type | Organization
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Legal Business Name | KEEP THE HOPE ALIVE, II, INC.
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Dates
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Enumeration Date | 12/26/2023
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 1110 GREENVILLE BLVD SE
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City | GREENVILLE
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State | NC
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Zip | 27858-4528
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Country | US
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Telephone | 252-215-0337
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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 |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | IESHA WALLACE
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Credential |
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Telephone | 704-390-2887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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