Provider Demographics
NPI:1457885857
Name:HOPEWELL SUPERVISED LIVING GROUP
Entity Type:Organization
Organization Name:HOPEWELL SUPERVISED LIVING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QP
Authorized Official - Phone:252-443-8200
Mailing Address - Street 1:3216 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2435
Mailing Address - Country:US
Mailing Address - Phone:252-443-8200
Mailing Address - Fax:252-443-6727
Practice Address - Street 1:3216 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2435
Practice Address - Country:US
Practice Address - Phone:252-443-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
NCMHL0640154251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty