Provider Demographics
NPI:1164048120
Name:QC HOUSE OF HOPE
Entity Type:Organization
Organization Name:QC HOUSE OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:HAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-476-0625
Mailing Address - Street 1:9915 TREESIDE LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7221
Mailing Address - Country:US
Mailing Address - Phone:704-476-0625
Mailing Address - Fax:
Practice Address - Street 1:9915 TREESIDE LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7221
Practice Address - Country:US
Practice Address - Phone:704-476-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health