=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588404271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE ESPERANZA RESTORATION AND EMPOWERMENT CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2024
-----------------------------------------------------
Last Update Date | 05/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 INDUSTRIAL PARK DR STE C
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-793-3800
-----------------------------------------------------
Fax | 240-222-3715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11288 BURBERRY ST
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20695-3187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-793-3800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | IESHA P ROSENBORO
-----------------------------------------------------
Credential | MA, LCPC
-----------------------------------------------------
Telephone | 301-793-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------