Provider Demographics
NPI:1568992683
Name:HOPE HOUSE SERVING NORTHEASTERN COLORADO
Entity Type:Organization
Organization Name:HOPE HOUSE SERVING NORTHEASTERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-380-7885
Mailing Address - Street 1:915 S DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4103
Mailing Address - Country:US
Mailing Address - Phone:970-380-7885
Mailing Address - Fax:888-719-5863
Practice Address - Street 1:915 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4103
Practice Address - Country:US
Practice Address - Phone:970-380-7885
Practice Address - Fax:888-719-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No251S00000XAgenciesCommunity/Behavioral Health