Provider Demographics
NPI:1568188266
Name:HOPE EVERGREEN LLC
Entity Type:Organization
Organization Name:HOPE EVERGREEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-250-5649
Mailing Address - Street 1:PO BOX 1421
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-0925
Mailing Address - Country:US
Mailing Address - Phone:901-250-5649
Mailing Address - Fax:228-400-7966
Practice Address - Street 1:8569 CORDES CIR STE 1
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-3317
Practice Address - Country:US
Practice Address - Phone:901-250-5649
Practice Address - Fax:228-400-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437483724OtherPERSONAL NPI