Provider Demographics
NPI: | 1477329860 |
---|---|
Name: | HOPE HAVEN RECOVERY AND CARE |
Entity Type: | Organization |
Organization Name: | HOPE HAVEN RECOVERY AND CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | REDEATE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LAKEW |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-904-0057 |
Mailing Address - Street 1: | 9535 FOREST LN STE 119A |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75243-5900 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 9535 FOREST LN STE 119A |
Practice Address - Street 2: | |
Practice Address - City: | DALLAS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75243-5900 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-904-0057 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-11-28 |
Last Update Date: | 2023-11-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
No | 311500000X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | |
No | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |