Basic Information
| Provider Information | |||||||||
| NPI: | 1265644702 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOOD HOPE INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 GOOD HOPE ROAD, SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200206910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026101886 | ||||||||
| FaxNumber: | 2026101887 | ||||||||
| Practice Location | |||||||||
| Address1: | 1320 GOOD HOPE ROAD, SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200206910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026101886 | ||||||||
| FaxNumber: | 2026101887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BERCH | ||||||||
| AuthorizedOfficialFirstName: | NEAL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2026101886 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | SA0400055 | DC | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | SA0400055 | 01 | DC | STATE DRUG CONTROL NUMBER | OTHER |