Provider Demographics
NPI:1235632969
Name:COMMUNITY HOPE HOME CARE
Entity Type:Organization
Organization Name:COMMUNITY HOPE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-791-2916
Mailing Address - Street 1:3140 S LAKE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1411
Mailing Address - Country:US
Mailing Address - Phone:606-886-8551
Mailing Address - Fax:606-886-8551
Practice Address - Street 1:3140 S LAKE DR STE 4
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1411
Practice Address - Country:US
Practice Address - Phone:606-886-8551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
KY500283251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services