Provider Demographics
NPI:1114179512
Name:HOPE FARM RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:HOPE FARM RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-578-0904
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-0581
Mailing Address - Country:US
Mailing Address - Phone:336-578-0904
Mailing Address - Fax:
Practice Address - Street 1:2832 NUREUS DR.
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-0581
Practice Address - Country:US
Practice Address - Phone:336-578-0904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL001-167320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities