Provider Demographics
NPI:1154649788
Name:GRAHAM'S HOUSE OF HOPE, LLC
Entity Type:Organization
Organization Name:GRAHAM'S HOUSE OF HOPE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PRENTISS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:251-457-6929
Mailing Address - Street 1:3626 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHISTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36612-1813
Mailing Address - Country:US
Mailing Address - Phone:251-457-6929
Mailing Address - Fax:251-452-9901
Practice Address - Street 1:3626 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHISTLER
Practice Address - State:AL
Practice Address - Zip Code:36612-1813
Practice Address - Country:US
Practice Address - Phone:251-457-6929
Practice Address - Fax:251-452-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities