Provider Demographics
NPI:1386780286
Name:MISSION HOPE DEVELOPMENTAL SERV INC
Entity type:Organization
Organization Name:MISSION HOPE DEVELOPMENTAL SERV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MS
Authorized Official - First Name:NIMFA
Authorized Official - Middle Name:YAMSUAN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-780-0832
Mailing Address - Street 1:1159 CITRON WAY
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2459
Mailing Address - Country:US
Mailing Address - Phone:510-780-0832
Mailing Address - Fax:925-560-5621
Practice Address - Street 1:1159 CITRON WAY
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2459
Practice Address - Country:US
Practice Address - Phone:510-780-0832
Practice Address - Fax:925-560-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities