Provider Demographics
NPI:1649949264
Name:HOPE AND HEALING WELLNESS CENTER,LLC
Entity type:Organization
Organization Name:HOPE AND HEALING WELLNESS CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FALGOUT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,NCC
Authorized Official - Phone:814-952-6496
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-0473
Mailing Address - Country:US
Mailing Address - Phone:484-373-9309
Mailing Address - Fax:
Practice Address - Street 1:628 TWIN PONDS RD
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1843
Practice Address - Country:US
Practice Address - Phone:484-373-9309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)