Provider Demographics
NPI:1558189795
Name:HOPE CENTER CLINIC, LLC
Entity type:Organization
Organization Name:HOPE CENTER CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:NCMA
Authorized Official - Phone:410-824-1480
Mailing Address - Street 1:1111 S ORCHARD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1961
Mailing Address - Country:US
Mailing Address - Phone:208-919-4692
Mailing Address - Fax:410-824-1482
Practice Address - Street 1:1111 S ORCHARD ST STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1961
Practice Address - Country:US
Practice Address - Phone:208-919-4692
Practice Address - Fax:410-824-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty