Provider Demographics
NPI:1588937379
Name:IC HOPE
Entity type:Organization
Organization Name:IC HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:804-363-8964
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-0793
Mailing Address - Country:US
Mailing Address - Phone:804-363-8964
Mailing Address - Fax:
Practice Address - Street 1:501 E FRANKLIN ST
Practice Address - Street 2:SUITE 717
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2322
Practice Address - Country:US
Practice Address - Phone:804-237-9420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102443251B00000X, 251S00000X, 101YA0400X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty