Provider Demographics
NPI:1437332285
Name:HOPE IN THE CAROLINA
Entity Type:Organization
Organization Name:HOPE IN THE CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-916-3929
Mailing Address - Street 1:PO BOX 1576
Mailing Address - Street 2:
Mailing Address - City:ROSEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28382-1576
Mailing Address - Country:US
Mailing Address - Phone:910-916-3929
Mailing Address - Fax:
Practice Address - Street 1:4479 HAYNE STRETCH RD
Practice Address - Street 2:
Practice Address - City:ROSEBORO
Practice Address - State:NC
Practice Address - Zip Code:28382-8436
Practice Address - Country:US
Practice Address - Phone:910-531-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-073322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC070539Medicaid