1790990984 NPI number — NEW HOPE COMMUNITY, INC.

Table of content: (NPI 1790990984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790990984 NPI number — NEW HOPE COMMUNITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HOPE COMMUNITY, INC.
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:
6
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:
1790990984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 289
Provider Second Line Business Mailing Address:
ROUTE 52
Provider Business Mailing Address City Name:
LOCH SHELDRAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12759-0289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-434-8300
Provider Business Mailing Address Fax Number:
845-436-7311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 LARRY'S WAY
Provider Second Line Business Practice Location Address:
ROUTE 52
Provider Business Practice Location Address City Name:
LOCH SHELDRAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12759-0289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-434-8300
Provider Business Practice Location Address Fax Number:
845-436-7311
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FORBES
Authorized Official First Name:
A. JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
845-434-8300

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  0452467 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02000104 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com