Provider Demographics
NPI:1427557123
Name:FORT OF HOPE LLC
Entity type:Organization
Organization Name:FORT OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINKADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-875-7435
Mailing Address - Street 1:12371 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2836
Mailing Address - Country:US
Mailing Address - Phone:713-875-7435
Mailing Address - Fax:
Practice Address - Street 1:5095 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-2053
Practice Address - Country:US
Practice Address - Phone:713-875-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDCARE PEDIATRIC GROUP, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities