Provider Demographics
NPI:1720244106
Name:HOPE INTENSIVE IN HOME SERVICES
Entity Type:Organization
Organization Name:HOPE INTENSIVE IN HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:COLEMAN
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-991-3491
Mailing Address - Street 1:18799 LOVING UNION RD
Mailing Address - Street 2:
Mailing Address - City:DISPUTANTA
Mailing Address - State:VA
Mailing Address - Zip Code:23842-7038
Mailing Address - Country:US
Mailing Address - Phone:804-991-3491
Mailing Address - Fax:804-991-3581
Practice Address - Street 1:17 HOLLYHILL DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2559
Practice Address - Country:US
Practice Address - Phone:804-863-2071
Practice Address - Fax:804-863-2073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX-N-PEACE ADULT CARE RESIDENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA40005001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health