Organization
KEEP HOPE ALIVE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MONICA D. WALLACE (DIRECTOR)
(252) 353-8003
Entity
Organization
Contact information
Practice address
3219 LANDMARK ST, SUITE 6, GREENVILLE, NC 27834-7688
(252) 353-8003
Mailing address
PO BOX 30557, GREENVILLE, NC 27833-0557
(252) 353-8003
(252) 353-9912
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-074-139
NC
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL-074-140
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409645
—
NC
05
—
6603981
—
NC
05
—
6603982
—
NC
05
—
8301166B
—
NC
Enumeration date
01/29/2007
Last updated
12/22/2015
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