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General NPI Number Information
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NPI Number | 1649949264
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Entity Type | Organization
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Legal Business Name | HOPE AND HEALING WELLNESS CENTER,LLC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 628 TWIN PONDS RD
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City | BREINIGSVILLE
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State | PA
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Zip | 18031-1843
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Country | US
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Telephone | 484-373-9309
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 473
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City | OREFIELD
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State | PA
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Zip | 18069-0473
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Country | US
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Telephone | 484-373-9309
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEREMY FALGOUT
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Credential | LPC,NCC
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Telephone | 814-952-6496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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