Provider Demographics
NPI:1841774270
Name:HOPE DRUG REHABILITATION LLC
Entity Type:Organization
Organization Name:HOPE DRUG REHABILITATION LLC
Other - Org Name:HOPE DRUG REHABILITATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-881-7928
Mailing Address - Street 1:5257 BIG TYLER RD
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1839
Mailing Address - Country:US
Mailing Address - Phone:681-217-1121
Mailing Address - Fax:681-217-1399
Practice Address - Street 1:5257 BIG TYLER RD
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1839
Practice Address - Country:US
Practice Address - Phone:304-881-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV467OtherWV DEPT OF HEALTH AND HUMAN SVCS