Provider Demographics
NPI:1891412870
Name:AUTHENTIC HOPE: CENTER FOR PEACE AND EMPOWERMENT
Entity Type:Organization
Organization Name:AUTHENTIC HOPE: CENTER FOR PEACE AND EMPOWERMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROETHLISBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MDIV
Authorized Official - Phone:541-974-8873
Mailing Address - Street 1:861 SW MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4512
Mailing Address - Country:US
Mailing Address - Phone:541-974-8873
Mailing Address - Fax:
Practice Address - Street 1:861 SW MADISON AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4512
Practice Address - Country:US
Practice Address - Phone:541-974-8873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty