Provider Demographics
NPI:1659702280
Name:HOPEFUL ORIGINS, LLC
Entity Type:Organization
Organization Name:HOPEFUL ORIGINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-863-5889
Mailing Address - Street 1:103 SOUTHERN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-1451
Mailing Address - Country:US
Mailing Address - Phone:410-420-8300
Mailing Address - Fax:443-267-0200
Practice Address - Street 1:5602 BALTIMORE NATIONAL PIKE SUITE 205
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1104
Practice Address - Country:US
Practice Address - Phone:410-420-8300
Practice Address - Fax:443-267-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-08
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1628686261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health