Provider Demographics
NPI:1144547670
Name:HOPES OF HONORABLE YOUTH, LLC
Entity type:Organization
Organization Name:HOPES OF HONORABLE YOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-797-7127
Mailing Address - Street 1:130 W WIEUCA RD NE STE 204B
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3288
Mailing Address - Country:US
Mailing Address - Phone:404-797-7126
Mailing Address - Fax:
Practice Address - Street 1:130 W WIEUCA RD NE STE 204B
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-3288
Practice Address - Country:US
Practice Address - Phone:404-797-7126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1000004730251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA623661151AMedicaid