Provider Demographics
NPI:1427326842
Name:VILLAGE OF HOPE, LLC
Entity type:Organization
Organization Name:VILLAGE OF HOPE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HAYDEN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:702-582-8635
Mailing Address - Street 1:9225 W CHARLESTON BLVD
Mailing Address - Street 2:2211
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7041
Mailing Address - Country:US
Mailing Address - Phone:702-582-8635
Mailing Address - Fax:
Practice Address - Street 1:9225 W CHARLESTON BLVD
Practice Address - Street 2:2211
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7041
Practice Address - Country:US
Practice Address - Phone:702-582-8635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538490776Medicaid