=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972094589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEEP HOPE ENTERPRISES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2018
-----------------------------------------------------
Last Update Date | 05/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5252 OLDE TOWNE RD STE A
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23188-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-201-3140
-----------------------------------------------------
Fax | 800-549-0901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 37453
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23234-7453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-201-3140
-----------------------------------------------------
Fax | 800-549-0901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AO
-----------------------------------------------------
Name | KENNETH ANTONIO HEATH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-201-3140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------