Provider Demographics
NPI:1669258133
Name:HOPE AND HEALING CLINIC LLC
Entity type:Organization
Organization Name:HOPE AND HEALING CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY CONTACT PERSON
Authorized Official - Prefix:
Authorized Official - First Name:JOSETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-961-1813
Mailing Address - Street 1:420 HOWANUT RD
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-9659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9474 LATHROP INDUSTRIAL DR SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:253-961-1813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder