Provider Demographics
NPI:1063679975
Name:HOPE COTTAGE LLC
Entity type:Organization
Organization Name:HOPE COTTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CFM
Authorized Official - Phone:910-944-2255
Mailing Address - Street 1:430 MAGNOLIA SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2228
Mailing Address - Country:US
Mailing Address - Phone:910-944-2255
Mailing Address - Fax:
Practice Address - Street 1:430 MAGNOLIA SQUARE CT
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2228
Practice Address - Country:US
Practice Address - Phone:910-944-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFH6000365OtherFIRST CAROLINA CARE PROVIDER NUMBER
NC9080229OtherFIRSTMEDICARE DIRECT
NCFH6000365OtherFIRST CAROLINA CARE PROVIDER NUMBER