Provider Demographics
NPI:1427545425
Name:HOPE AND FAITH CENTER LLC
Entity Type:Organization
Organization Name:HOPE AND FAITH CENTER LLC
Other - Org Name:MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:321-443-6281
Mailing Address - Street 1:2825 WAGON WHEEL TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8985
Mailing Address - Country:US
Mailing Address - Phone:321-443-6281
Mailing Address - Fax:
Practice Address - Street 1:2260 E IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4421
Practice Address - Country:US
Practice Address - Phone:321-443-6281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management