Provider Demographics
NPI:1679863781
Name:OUNCE OF HOPE LLC
Entity Type:Organization
Organization Name:OUNCE OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TAYLOR-BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CSAC, CRP
Authorized Official - Phone:757-735-9252
Mailing Address - Street 1:210 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5606
Mailing Address - Country:US
Mailing Address - Phone:757-735-9252
Mailing Address - Fax:
Practice Address - Street 1:140 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5254
Practice Address - Country:US
Practice Address - Phone:757-735-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0715005473251C00000X, 251S00000X
VA0710102607251S00000X
VA110909B251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0710102607Medicaid
VA1750611042Medicaid
VA0710102607Medicaid
VA1750611042Medicare PIN
VA1750611042Medicaid
VA1750611042Medicare Oscar/Certification