Provider Demographics
NPI:1346902624
Name:2 HOPE BEHAVIORAL CENTER
Entity Type:Organization
Organization Name:2 HOPE BEHAVIORAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-300-5184
Mailing Address - Street 1:3401 S 78TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-6513
Mailing Address - Country:US
Mailing Address - Phone:813-453-0502
Mailing Address - Fax:813-885-6092
Practice Address - Street 1:3401 S 78TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6513
Practice Address - Country:US
Practice Address - Phone:813-453-0502
Practice Address - Fax:813-885-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty