Organization
HARBOR OF HOPE MEDICAL AND BEHAVIORAL HEALTH CARE, LLC
Active
Parent organization
HARBOR OF HOPE MEDICAL AND BEHAVIORAL HEALTH CARE, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
HARBOR OF HOPE MEDICAL AND BEHAVIORAL HEALTH CARE, LLC
Authorized official
MRS. THELMA J GRAY APRN (OWNER)
(606) 269-3428
Entity
Organization
Contact information
Practice address
185 TREUHAFT BLVD APT 4, BARBOURVILLE, KY 40906-8300
(606) 545-6766
Mailing address
868 SAM PARKER RD, GRAY, KY 40734-6780
(606) 269-3428
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100615630
—
KY
Enumeration date
11/11/2019
Last updated
04/13/2020
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