Provider Demographics
NPI:1962631077
Name:SOROPTIMIST HOUSE OF HOPE, INC.
Entity Type:Organization
Organization Name:SOROPTIMIST HOUSE OF HOPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A OMA
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:951-849-9491
Mailing Address - Street 1:628 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-4512
Mailing Address - Country:US
Mailing Address - Phone:951-849-9491
Mailing Address - Fax:951-849-8262
Practice Address - Street 1:628 S 8TH ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-4512
Practice Address - Country:US
Practice Address - Phone:951-849-9491
Practice Address - Fax:951-849-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330016BN324500000X
CA330016AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility