Provider Demographics
NPI:1114265246
Name:NEW HOPE CDU LLC
Entity Type:Organization
Organization Name:NEW HOPE CDU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:FOLSTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:580-782-3337
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-0386
Mailing Address - Country:US
Mailing Address - Phone:580-782-3337
Mailing Address - Fax:
Practice Address - Street 1:2 WICKERSHAM ST
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-9117
Practice Address - Country:US
Practice Address - Phone:580-782-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK607261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)