Provider Demographics
NPI:1841062858
Name:HARBOR OF HOPE LLC
Entity type:Organization
Organization Name:HARBOR OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIBAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-860-0616
Mailing Address - Street 1:10011 SE DIVISION ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1354
Mailing Address - Country:US
Mailing Address - Phone:503-964-5182
Mailing Address - Fax:503-964-5261
Practice Address - Street 1:10011 SE DIVISION ST STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1354
Practice Address - Country:US
Practice Address - Phone:503-964-5182
Practice Address - Fax:503-964-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)