Provider Demographics
NPI:1578718680
Name:HOPE YOUTH RANCH, INC.
Entity Type:Organization
Organization Name:HOPE YOUTH RANCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-232-0119
Mailing Address - Street 1:17933 EAST RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6074
Mailing Address - Country:US
Mailing Address - Phone:727-232-0119
Mailing Address - Fax:727-233-0628
Practice Address - Street 1:17933 EAST RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6074
Practice Address - Country:US
Practice Address - Phone:727-232-0119
Practice Address - Fax:727-233-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0808-103251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health