MEDICARE: A RHAEA HOPE, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1992279988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A RHAEA HOPE, LLC

Provider Business Mailing Address
First Line	:	950 N WASHINGTON ST FL 3
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2398
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N WASHINGTON ST FL 3
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2398
Country	:	US
Telephone Number	:	757-621-8049
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RHAEA GOFF
Credential	:
Telephone Number	:	757-621-8049

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	09/30/2022

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