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NPI Code Detail

MEDICARE: HOPE CLUBHOUSE OF SOUTHWEST FLORIDA, INC.

MEDICARE: HOPE CLUBHOUSE OF SOUTHWEST FLORIDA, 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1427492396
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPE CLUBHOUSE OF SOUTHWEST FLORIDA, INC.
Provider Business Mailing Address
First Line : 3602 BROADWAY
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-8005
Country : US
Telephone Number : 239-267-1777
Fax Number : 239-267-1774
Provider Business Practice Location Address
First Line : 3602 BROADWAY
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-8005
Country : US
Telephone Number : 239-267-1777
Fax Number : 239-267-1774
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : AIME KUNES
Credential : LMHC
Telephone Number : 239-267-1777
Provider Enumeration Date : 04/23/2013
Last Update Date : 02/05/2014

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