Provider Demographics
NPI:1891397097
Name:GUIDED HOPE LLC
Entity Type:Organization
Organization Name:GUIDED HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:EE
Authorized Official - Last Name:DUBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-574-3789
Mailing Address - Street 1:429 LIVERNOIS ST # L1
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2385
Mailing Address - Country:US
Mailing Address - Phone:248-658-8109
Mailing Address - Fax:
Practice Address - Street 1:429 LIVERNOIS ST # L1
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2385
Practice Address - Country:US
Practice Address - Phone:248-658-8109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)