Provider Demographics
NPI:1053764985
Name:HOPE CENTERS OF CENTRAL FLORIDA, LLC
Entity type:Organization
Organization Name:HOPE CENTERS OF CENTRAL FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-445-9545
Mailing Address - Street 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5718
Mailing Address - Country:US
Mailing Address - Phone:407-445-9545
Mailing Address - Fax:407-299-9141
Practice Address - Street 1:101 E MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2123
Practice Address - Country:US
Practice Address - Phone:407-246-6620
Practice Address - Fax:407-299-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty