Provider Demographics
NPI:1972010049
Name:ONE HOPE, LLC
Entity Type:Organization
Organization Name:ONE HOPE, LLC
Other - Org Name:ONE HOPE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:ROSHELLE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:601-473-2160
Mailing Address - Street 1:101 AUBURN DR STE B
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6001
Mailing Address - Country:US
Mailing Address - Phone:601-473-2160
Mailing Address - Fax:601-473-2336
Practice Address - Street 1:101 AUBURN DR STE B
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-6001
Practice Address - Country:US
Practice Address - Phone:601-473-2160
Practice Address - Fax:601-473-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOH-AGENCY261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSOH-AGENCYOtherTHE MS DEPARTMENT OF MENTAL HEALTH