Provider Demographics
NPI:1285872036
Name:FACES OF HOPE CHILDREN'S THERAPY CENTER
Entity type:Organization
Organization Name:FACES OF HOPE CHILDREN'S THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FACE-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:615-206-1176
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-0012
Mailing Address - Country:US
Mailing Address - Phone:615-206-1176
Mailing Address - Fax:615-206-1177
Practice Address - Street 1:185 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2764
Practice Address - Country:US
Practice Address - Phone:615-206-1176
Practice Address - Fax:615-206-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517636Medicaid