MEDICARE: HOPEFUL HOMES, 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	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1558962233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPEFUL HOMES, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 1263
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-1263
Country	:	US
Telephone Number	:	706-751-7757
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PLEASANT HOME RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3520
Country	:	US
Telephone Number	:	706-751-7757
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AMY LAWRENCE
Credential	:
Telephone Number	:	843-478-5045

Provider Enumeration Date	:	11/08/2020
Last Update Date	:	11/08/2020

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