Provider Demographics
NPI:1740051325
Name:FULFILLING HOPE HUMAN SERVICES LLC
Entity type:Organization
Organization Name:FULFILLING HOPE HUMAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-252-5235
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-0184
Mailing Address - Country:US
Mailing Address - Phone:208-252-5235
Mailing Address - Fax:208-292-6661
Practice Address - Street 1:15464 N VERNON ST
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-8363
Practice Address - Country:US
Practice Address - Phone:208-252-5235
Practice Address - Fax:208-292-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)