1730464165 NPI number — NEW HOPE YOUTH & FAMILY SERVICES OF GASTONIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730464165 NPI number — NEW HOPE YOUTH & FAMILY SERVICES OF GASTONIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HOPE YOUTH & FAMILY SERVICES OF GASTONIA
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:
Provider Other Organization Name Type Code:
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:
1730464165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5736 N TRYON ST
Provider Second Line Business Mailing Address:
SUITE 128
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28213-6850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-361-5395
Provider Business Mailing Address Fax Number:
980-207-5647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 S NEW HOPE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-361-5395
Provider Business Practice Location Address Fax Number:
980-207-5647
Provider Enumeration Date:
10/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SHANKLE
Authorized Official First Name:
OCTAVIA
Authorized Official Middle Name:
DEVONNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-361-5395

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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