MEDICARE: CITY OF HOPE INTERNATIONAL, INC.

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1306572037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF HOPE INTERNATIONAL, INC.

Provider Business Mailing Address
First Line	:	PO BOX 540
Second Line	:
City	:	WILDWOOD
State	:	FL
Zip	:	34785-0540
Country	:	US
Telephone Number	:	352-348-0840
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 CLEVELAND AVE
Second Line	:
City	:	WILDWOOD
State	:	FL
Zip	:	34785-3502
Country	:	US
Telephone Number	:	352-348-0840
Fax Number	:

Authorized Official
Title or Position	:	BOARD PRESIDENT
Name	:	MRS. MARY A. STARKEY
Credential	:	N/A
Telephone Number	:	352-348-0840

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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