MEDICARE: THE HOPE CENTER OF CARMODY HILLS

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	302R00000X	Health Maintenance Organization	LC3332	MD

General Provider Information

NPI Number	:	1508392895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HOPE CENTER OF CARMODY HILLS

Provider Business Mailing Address
First Line	:	6501 SEAT PLEASANT DR
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-6016
Country	:	US
Telephone Number	:	240-719-2699
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 SEAT PLEASANT DR
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-6016
Country	:	US
Telephone Number	:	240-719-2699
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JOANNE FREDERICK LEIVA
Credential	:	ED.D, NCC, LPC, LCPC
Telephone Number	:	240-719-2699

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	05/04/2017

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