Provider Demographics
NPI:1760749576
Name:NEW HOPE CDU, LLC
Entity Type:Organization
Organization Name:NEW HOPE CDU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-928-3200
Mailing Address - Street 1:501 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-1907
Mailing Address - Country:US
Mailing Address - Phone:580-928-3200
Mailing Address - Fax:405-928-8983
Practice Address - Street 1:2 WICKERSHAM ST
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-9117
Practice Address - Country:US
Practice Address - Phone:580-782-3337
Practice Address - Fax:580-782-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2015-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility