Provider Demographics
NPI:1528404829
Name:HOUSE OF HOPE LIFE SHARER HOME, LTD.
Entity Type:Organization
Organization Name:HOUSE OF HOPE LIFE SHARER HOME, LTD.
Other - Org Name:HOUSE OF HOPE LSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MURCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-497-5666
Mailing Address - Street 1:7984 FLANDERS CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-2114
Mailing Address - Country:US
Mailing Address - Phone:678-497-5666
Mailing Address - Fax:
Practice Address - Street 1:7984 FLANDERS CT
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-2114
Practice Address - Country:US
Practice Address - Phone:678-497-5666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACLA000916251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health