Provider Demographics
NPI:1073809497
Name:HOPE SERVICE OF NORTH CAROLINA LLC
Entity Type:Organization
Organization Name:HOPE SERVICE OF NORTH CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-615-7448
Mailing Address - Street 1:5500 FORTUNES RIDGE DR
Mailing Address - Street 2:APT 74B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5500 FORTUNES RIDGE DR
Practice Address - Street 2:APT 74B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9365
Practice Address - Country:US
Practice Address - Phone:336-615-7448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health