Provider Demographics
NPI:1750158556
Name:HARBOR OF HOPE LLC
Entity type:Organization
Organization Name:HARBOR OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HIETHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-477-7725
Mailing Address - Street 1:929 PORTLAND AVE APT 1807
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1268
Mailing Address - Country:US
Mailing Address - Phone:571-477-7725
Mailing Address - Fax:
Practice Address - Street 1:929 PORTLAND AVE APT 1807
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1268
Practice Address - Country:US
Practice Address - Phone:571-477-7725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health