1780310839 NPI number — HOUSE OF HOPE BEHAVIORAL CENTER

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 1780310839 NPI number — HOUSE OF HOPE BEHAVIORAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSE OF HOPE BEHAVIORAL CENTER
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:
1780310839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1075 HARBOR TOWN CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89436-1821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-379-8810
Provider Business Mailing Address Fax Number:
775-384-6685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2205 LAS VERDES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
705-682-4855
Provider Business Practice Location Address Fax Number:
775-384-6685
Provider Enumeration Date:
07/29/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
TRENA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
775-379-8810

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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