Provider Demographics
NPI:1982335386
Name:HOPE FOR HEALING LLC
Entity Type:Organization
Organization Name:HOPE FOR HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-303-0154
Mailing Address - Street 1:18 ATLEY HOLMES ROAD
Mailing Address - Street 2:
Mailing Address - City:JAYESS
Mailing Address - State:MS
Mailing Address - Zip Code:39641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:929 HWY 27 NORTH
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667
Practice Address - Country:US
Practice Address - Phone:601-303-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09536589Medicaid