Provider Demographics
NPI:1053956672
Name:HOPEVILLE HOMES HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:HOPEVILLE HOMES HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:763-843-8850
Mailing Address - Street 1:11330 FLORIDA AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3390
Mailing Address - Country:US
Mailing Address - Phone:763-843-8850
Mailing Address - Fax:
Practice Address - Street 1:11330 FLORIDA AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3390
Practice Address - Country:US
Practice Address - Phone:763-843-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health