1013182104 NPI number — HOPE THE HABAKKUK FOUNDATION

Table of content: (NPI 1013182104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013182104 NPI number — HOPE THE HABAKKUK FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPE THE HABAKKUK FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOPE RESPITE CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013182104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
382 GAMMON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27315-9631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-988-8484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
382 GAMMON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27315-9631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-988-8484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DONNELL
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
336-988-8484

Provider Taxonomy Codes

  • Taxonomy code: 320700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2055X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385HR2065X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 251S00000X , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".