Provider Demographics
NPI:1265511174
Name:SHADES OF HOPE LP
Entity Type:Organization
Organization Name:SHADES OF HOPE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BALCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-572-3843
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GAP
Mailing Address - State:TX
Mailing Address - Zip Code:79508-0639
Mailing Address - Country:US
Mailing Address - Phone:325-572-3843
Mailing Address - Fax:325-572-3405
Practice Address - Street 1:402-A MULBERRY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO GAP
Practice Address - State:TX
Practice Address - Zip Code:79508
Practice Address - Country:US
Practice Address - Phone:325-572-3843
Practice Address - Fax:325-572-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549-A323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility