Provider Demographics
NPI:1932706603
Name:HEAVEN'S HOPE LLC
Entity type:Organization
Organization Name:HEAVEN'S HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:573-528-6527
Mailing Address - Street 1:19642 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-3542
Mailing Address - Country:US
Mailing Address - Phone:573-528-6527
Mailing Address - Fax:
Practice Address - Street 1:25300 RIO ROAD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556
Practice Address - Country:US
Practice Address - Phone:573-528-6527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility