Provider Demographics
NPI:1033461298
Name:COMMUNITY HOPE AGENCY, INC.
Entity Type:Organization
Organization Name:COMMUNITY HOPE AGENCY, INC.
Other - Org Name:HOPE HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:FLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-251-0954
Mailing Address - Street 1:3915 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-2007
Mailing Address - Country:US
Mailing Address - Phone:615-251-0954
Mailing Address - Fax:615-251-1103
Practice Address - Street 1:3915 MALLARD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-2007
Practice Address - Country:US
Practice Address - Phone:615-251-0954
Practice Address - Fax:615-251-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000007180302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization