Provider Demographics
NPI:1497186399
Name:EMBASSY OF HOPE SA, INC.
Entity Type:Organization
Organization Name:EMBASSY OF HOPE SA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-305-5155
Mailing Address - Street 1:11230 WEST AVE
Mailing Address - Street 2:SUITE #1103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1350
Mailing Address - Country:US
Mailing Address - Phone:210-305-5155
Mailing Address - Fax:210-305-5156
Practice Address - Street 1:11230 WEST AVE
Practice Address - Street 2:SUITE #1103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1350
Practice Address - Country:US
Practice Address - Phone:210-305-5155
Practice Address - Fax:210-305-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty