Provider Demographics
NPI:1497152532
Name:HOPE FOR CHANGE
Entity Type:Organization
Organization Name:HOPE FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-253-5286
Mailing Address - Street 1:1524 BALLARD CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7938
Mailing Address - Country:US
Mailing Address - Phone:336-253-5286
Mailing Address - Fax:
Practice Address - Street 1:131 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7324
Practice Address - Country:US
Practice Address - Phone:336-253-5286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5796251S00000X
NC9787251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherONLY EIN IDENTIFIER AT THIS TIME