Provider Demographics
NPI:1659630416
Name:HOPE SUPPORT SYSTEMS INC
Entity Type:Organization
Organization Name:HOPE SUPPORT SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-300-6455
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-3012
Mailing Address - Country:US
Mailing Address - Phone:704-487-6666
Mailing Address - Fax:704-487-6936
Practice Address - Street 1:6 BOLT DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4024
Practice Address - Country:US
Practice Address - Phone:704-487-6666
Practice Address - Fax:704-487-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health