Provider Demographics
NPI:1619042421
Name:GATHERING HOPE HOUSE
Entity Type:Organization
Organization Name:GATHERING HOPE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:440-233-7400
Mailing Address - Street 1:1173 N RIDGE RD E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3032
Mailing Address - Country:US
Mailing Address - Phone:440-233-7400
Mailing Address - Fax:440-233-7411
Practice Address - Street 1:1173 N RIDGE RD E
Practice Address - Street 2:SUITE 102
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3032
Practice Address - Country:US
Practice Address - Phone:440-233-7400
Practice Address - Fax:440-233-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health