Provider Demographics
NPI:1124492459
Name:HOPE HAVEN, LTD
Entity type:Organization
Organization Name:HOPE HAVEN, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MARINICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-545-9009
Mailing Address - Street 1:144 WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-2303
Mailing Address - Country:US
Mailing Address - Phone:501-545-9009
Mailing Address - Fax:501-643-9992
Practice Address - Street 1:500 W 23RD ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8129
Practice Address - Country:US
Practice Address - Phone:870-777-8655
Practice Address - Fax:870-777-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR407310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR209888794Medicaid