MEDICARE: SOLI HOPE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1033868849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLI HOPE LLC

Provider Business Mailing Address
First Line	:	3509 HARRISON ST
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68147-1252
Country	:	US
Telephone Number	:	531-541-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 HARRISON ST
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68147-1252
Country	:	US
Telephone Number	:	531-541-2840
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOELLE ADJINATA
Credential	:	CEO
Telephone Number	:	531-541-2840

Provider Enumeration Date	:	03/20/2022
Last Update Date	:	03/20/2022

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Directions to “SOLI HOPE LLC ” Practice Location

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