1396359576 NPI number — BEST HOPE COMMUNITY RESIDENTIAL SERVICES

Table of content: (NPI 1396359576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396359576 NPI number — BEST HOPE COMMUNITY RESIDENTIAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEST HOPE COMMUNITY RESIDENTIAL SERVICES
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:
1396359576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17571 GRAHAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUMFRIES
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22026-2342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-931-0059
Provider Business Mailing Address Fax Number:
703-763-2876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9662 HAWKSHEAD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22079-2786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-931-0059
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KANU
Authorized Official First Name:
GINNEFINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
571-931-0059

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 474847373 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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