Provider Demographics
NPI:1073097531
Name:MINISTRY FOR HOPE, INC. MONTFORT THERAPEUTIC RESIDENCE
Entity Type:Organization
Organization Name:MINISTRY FOR HOPE, INC. MONTFORT THERAPEUTIC RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GERACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-928-5223
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-928-5223
Mailing Address - Fax:631-928-4466
Practice Address - Street 1:100 STONYHILL ROAD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-928-5223
Practice Address - Fax:631-928-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities