Provider Demographics
NPI:1760148720
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:M
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-420-8300
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:
Mailing Address - Fax:443-267-0020
Practice Address - Street 1:1701 K ST NW STE 900
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1513
Practice Address - Country:US
Practice Address - Phone:800-457-5020
Practice Address - Fax:443-267-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)