Provider Demographics
NPI:1427492396
Name:HOPE CLUBHOUSE OF SOUTHWEST FLORIDA, INC.
Entity type:Organization
Organization Name:HOPE CLUBHOUSE OF SOUTHWEST FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AIME
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:239-267-1777
Mailing Address - Street 1:3602 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8005
Mailing Address - Country:US
Mailing Address - Phone:239-267-1777
Mailing Address - Fax:239-267-1774
Practice Address - Street 1:3602 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8005
Practice Address - Country:US
Practice Address - Phone:239-267-1777
Practice Address - Fax:239-267-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health