Provider Demographics
NPI:1760928212
Name:LIVING HOPE RECOVERY CENTER
Entity Type:Organization
Organization Name:LIVING HOPE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONBOARDING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELI
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-672-8345
Mailing Address - Street 1:1531 SW COMMERCIAL GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0454
Mailing Address - Country:US
Mailing Address - Phone:386-365-4635
Mailing Address - Fax:
Practice Address - Street 1:1531 SW COMMERCIAL GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0454
Practice Address - Country:US
Practice Address - Phone:386-365-4635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care