Provider Demographics
NPI:1962861203
Name:VALLEY OF HOPE
Entity Type:Organization
Organization Name:VALLEY OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHP
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:318-572-8383
Mailing Address - Street 1:4609 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-2900
Mailing Address - Country:US
Mailing Address - Phone:318-626-5462
Mailing Address - Fax:318-626-5562
Practice Address - Street 1:4609 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2900
Practice Address - Country:US
Practice Address - Phone:318-626-5462
Practice Address - Fax:318-626-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health