Provider Demographics
NPI:1841784816
Name:HOPE ADULT GROUP HOME
Entity Type:Organization
Organization Name:HOPE ADULT GROUP HOME
Other - Org Name:HOPE ADULT GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:DESSALINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-291-4353
Mailing Address - Street 1:96 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-1634
Mailing Address - Country:US
Mailing Address - Phone:617-291-4353
Mailing Address - Fax:
Practice Address - Street 1:96 OLIVER ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MA
Practice Address - Zip Code:02322-1634
Practice Address - Country:US
Practice Address - Phone:617-291-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN262190163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0Medicaid