Provider Demographics
NPI:1063946796
Name:HOPE HEALTH AND HEALING CLINIC
Entity type:Organization
Organization Name:HOPE HEALTH AND HEALING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:GARDNER
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:615-732-0415
Mailing Address - Street 1:1375 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-1423
Mailing Address - Country:US
Mailing Address - Phone:615-732-0415
Mailing Address - Fax:615-577-3772
Practice Address - Street 1:1375 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-1423
Practice Address - Country:US
Practice Address - Phone:615-732-0415
Practice Address - Fax:615-577-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000830915261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care