Provider Demographics
NPI:1700079639
Name:HOPE CLINIC
Entity Type:Organization
Organization Name:HOPE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASSKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH, FNP
Authorized Official - Phone:949-515-6725
Mailing Address - Street 1:2777 DEL MONTE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3811
Mailing Address - Country:US
Mailing Address - Phone:916-375-1707
Mailing Address - Fax:916-375-1735
Practice Address - Street 1:2045 MEYER PL
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2967
Practice Address - Country:US
Practice Address - Phone:949-515-6725
Practice Address - Fax:949-515-6726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWPORT-MESA UNIFIED SCHOOL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30-66597OtherMEDI-CAL