Provider Demographics
| NPI: | 1033991906 |
|---|---|
| Name: | PRIMARY HOPE OUTREACH CENTER LLC |
| Entity type: | Organization |
| Organization Name: | PRIMARY HOPE OUTREACH CENTER LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | RASHAUNDA |
| Authorized Official - Middle Name: | LAKEI |
| Authorized Official - Last Name: | PETTIFORD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 336-417-4164 |
| Mailing Address - Street 1: | 1724 SETTER DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BURLINGTON |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 27217-9444 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 336-417-4164 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1724 SETTER DR |
| Practice Address - Street 2: | |
| Practice Address - City: | BURLINGTON |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27217-9444 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 336-417-4164 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-10-16 |
| Last Update Date: | 2023-11-09 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | ||
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone | |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
