Provider Demographics
NPI:1174036156
Name:HOUSE OF HOPE
Entity Type:Organization
Organization Name:HOUSE OF HOPE
Other - Org Name:HEALTHY MINDS INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-239-3890
Mailing Address - Street 1:209 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4543
Mailing Address - Country:US
Mailing Address - Phone:318-239-3890
Mailing Address - Fax:
Practice Address - Street 1:222 W HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4552
Practice Address - Country:US
Practice Address - Phone:318-239-3890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY MINDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783395320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA465660466Medicaid