Provider Demographics
NPI:1629533427
Name:BLUE HOPE SUPPORTIVE CARE LLC
Entity Type:Organization
Organization Name:BLUE HOPE SUPPORTIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-848-9640
Mailing Address - Street 1:260 NESBIT TER
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1773
Mailing Address - Country:US
Mailing Address - Phone:973-868-9640
Mailing Address - Fax:
Practice Address - Street 1:260 NESBIT TER
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1773
Practice Address - Country:US
Practice Address - Phone:973-943-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE HOPE SUPPORTIVE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0409308Medicaid