MEDICARE: HOUSE OF HOPE AT SPRING, 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1508541046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE OF HOPE AT SPRING, LLC

Provider Business Mailing Address
First Line	:	1324 LEMM ROAD 2
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-5788
Country	:	US
Telephone Number	:	346-758-2409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 LEMM ROAD 2
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-5788
Country	:	US
Telephone Number	:	346-758-2409
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARINDA TURKSON-OLADIMEJI
Credential	:
Telephone Number	:	346-758-2409

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	06/21/2023

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