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NPI Code Detail

MEDICARE: HOPE EVERGREEN LLC

MEDICARE: HOPE EVERGREEN 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
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11437483724OTHERPERSONAL NPI

General Provider Information

NPI Number : 1568188266
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPE EVERGREEN LLC
Provider Business Mailing Address
First Line : PO BOX 1421
Second Line :
City : OLIVE BRANCH
State : MS
Zip : 38654-0925
Country : US
Telephone Number : 901-250-5649
Fax Number : 228-400-7966
Provider Business Practice Location Address
First Line : 8569 CORDES CIR STE 1
Second Line :
City : GERMANTOWN
State : TN
Zip : 38139-3317
Country : US
Telephone Number : 901-250-5649
Fax Number : 228-400-7966
Authorized Official
Title or Position : BUSINESS OWNER
Name : MRS. KATHERYN MCLENDON
Credential : LCSW
Telephone Number : 901-250-5649
Provider Enumeration Date : 10/13/2022
Last Update Date : 10/13/2022

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Directions to “HOPE EVERGREEN LLC ” Practice Location

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