Provider Demographics
NPI:1760136386
Name:HOPELAND HOMES LLC
Entity Type:Organization
Organization Name:HOPELAND HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WAIVER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-218-3475
Mailing Address - Street 1:8218 SWANN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3611
Mailing Address - Country:US
Mailing Address - Phone:951-218-3475
Mailing Address - Fax:
Practice Address - Street 1:8218 SWANN HOLLOW DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3611
Practice Address - Country:US
Practice Address - Phone:951-218-3475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103906900Medicaid