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NPI Code Detail

MEDICARE: HOPE HAVEN YOUTH SERVICES LLC

MEDICARE: HOPE HAVEN YOUTH SERVICES 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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1790632446
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPE HAVEN YOUTH SERVICES LLC
Provider Business Mailing Address
First Line : 6400 ZIEGLER LN
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-3300
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6400 ZIEGLER LN
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-3300
Country : US
Telephone Number : 704-769-5546
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KAREEM SHAW
Credential :
Telephone Number : 704-769-5546
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “HOPE HAVEN YOUTH SERVICES LLC ” Practice Location

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