Provider Demographics
NPI:1659189652
Name:HOPE LEADERSHIP CLUB OF PRINCE GEORGES COUNTY
Entity type:Organization
Organization Name:HOPE LEADERSHIP CLUB OF PRINCE GEORGES COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-254-9553
Mailing Address - Street 1:252 FOREST OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-7530
Mailing Address - Country:US
Mailing Address - Phone:301-254-9553
Mailing Address - Fax:
Practice Address - Street 1:3592 FRONT ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2220
Practice Address - Country:US
Practice Address - Phone:301-254-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services