Provider Demographics
NPI:1710573720
Name:HOPE RECOVERY AND HEALING, LLC
Entity Type:Organization
Organization Name:HOPE RECOVERY AND HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:KETTERING
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:385-240-0321
Mailing Address - Street 1:575 EDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9446
Mailing Address - Country:US
Mailing Address - Phone:435-999-3038
Mailing Address - Fax:
Practice Address - Street 1:575 EDGEHILL DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9446
Practice Address - Country:US
Practice Address - Phone:435-999-3038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty