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General NPI Number Information
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NPI Number | 1629377080
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Entity Type | Organization
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Legal Business Name | NEW HOPE, LLC
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 527 W MACCLENNY AVE
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City | MACCLENNY
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State | FL
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Zip | 32063-2037
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Country | US
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Telephone | 904-704-2527
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Fax | 866-366-3884
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Provider Business Mailing Address
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Address Line | 527 W MACCLENNY AVE
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City | MACCLENNY
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State | FL
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Zip | 32063-2037
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Country | US
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Telephone | 904-704-2527
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Fax | 866-366-3884
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | TRACY RILEY
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Credential | LCSW
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Telephone | 904-704-2527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9355
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License Number State | FL
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