Provider Demographics
NPI:1013182104
Name:HOPE THE HABAKKUK FOUNDATION
Entity Type:Organization
Organization Name:HOPE THE HABAKKUK FOUNDATION
Other - Org Name:HOPE RESPITE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-988-8484
Mailing Address - Street 1:382 GAMMON RD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:NC
Mailing Address - Zip Code:27315-9631
Mailing Address - Country:US
Mailing Address - Phone:336-988-8484
Mailing Address - Fax:
Practice Address - Street 1:382 GAMMON RD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:NC
Practice Address - Zip Code:27315-9631
Practice Address - Country:US
Practice Address - Phone:336-988-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE THE HABAKKUK FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC251S00000XMedicaid