Provider Demographics
NPI:1134423239
Name:MY HOPE THERAPEUTIC AGENCY, INC.
Entity type:Organization
Organization Name:MY HOPE THERAPEUTIC AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-251-2411
Mailing Address - Street 1:12039 SW 132ND CT
Mailing Address - Street 2:28-1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4783
Mailing Address - Country:US
Mailing Address - Phone:305-251-2411
Mailing Address - Fax:305-251-2412
Practice Address - Street 1:12039 SW 132ND CT
Practice Address - Street 2:28-1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4783
Practice Address - Country:US
Practice Address - Phone:305-251-2411
Practice Address - Fax:305-251-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002540700OtherMEDICAID WAIVER