Provider Demographics
NPI:1194105833
Name:HOPE HOUSE; A DIVISION OF CATHOLIC FAMILY AND COMMUNITY SERVICES
Entity type:Organization
Organization Name:HOPE HOUSE; A DIVISION OF CATHOLIC FAMILY AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SILBERNAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:973-279-7100
Mailing Address - Street 1:24 DEGRASSE ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-2001
Mailing Address - Country:US
Mailing Address - Phone:973-279-7100
Mailing Address - Fax:
Practice Address - Street 1:19-21 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4107
Practice Address - Country:US
Practice Address - Phone:973-361-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC FAMILY AND COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101620204261QM0801X
NJ2000442261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0419095Medicaid
NJ0353965Medicaid
NJ0356221Medicaid