Provider Demographics
NPI:1720268949
Name:GRAPEVINE VALLEY HOPE
Entity Type:Organization
Organization Name:GRAPEVINE VALLEY HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCDC
Authorized Official - Phone:817-424-9013
Mailing Address - Street 1:2300 WILLIAM D TATE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3919
Mailing Address - Country:US
Mailing Address - Phone:817-424-9013
Mailing Address - Fax:817-329-0974
Practice Address - Street 1:2300 WILLIAM D TATE AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3919
Practice Address - Country:US
Practice Address - Phone:817-424-9013
Practice Address - Fax:817-329-0974
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY HOPE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9838101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty