Basic Information
| Provider Information | |||||||||
| NPI: | 1730509993 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | H3 - HOPE HEALING & HEALTH INC | ||||||||
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| OtherOrganizationName: | H3 - HOPE, HEALING & HEALTH, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23100 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | ST. CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480802057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863352006 | ||||||||
| FaxNumber: | 5862793886 | ||||||||
| Practice Location | |||||||||
| Address1: | 23100 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | ST. CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480802057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863352006 | ||||||||
| FaxNumber: | 5862793886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2014 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PALEN | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5863352006 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801086644 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.