Provider Demographics
NPI:1609468586
Name:HOME OF HOPE LLC
Entity Type:Organization
Organization Name:HOME OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:ABDULLAHI
Authorized Official - Last Name:MOHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-417-3754
Mailing Address - Street 1:2901 MOUNDS VIEW BLVD APT 215
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-0029
Mailing Address - Country:US
Mailing Address - Phone:651-417-3754
Mailing Address - Fax:
Practice Address - Street 1:2901 MOUNDS VIEW BLVD APT 215
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-0029
Practice Address - Country:US
Practice Address - Phone:651-417-3754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children