Provider Demographics
NPI:1588443766
Name:HOPE RESIDENCE, LLC
Entity type:Organization
Organization Name:HOPE RESIDENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT SUPPORT STAFF
Authorized Official - Prefix:
Authorized Official - First Name:AWAH
Authorized Official - Middle Name:MAWAH
Authorized Official - Last Name:MUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-441-8553
Mailing Address - Street 1:14526 FULLERTON RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2035
Mailing Address - Country:US
Mailing Address - Phone:240-441-8553
Mailing Address - Fax:
Practice Address - Street 1:14526 FULLERTON RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2035
Practice Address - Country:US
Practice Address - Phone:240-441-8553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities