Provider Demographics
NPI:1730485905
Name:SOUTHSIDE BEHAVIORAL HEALTH - HOPE HOUSE
Entity type:Organization
Organization Name:SOUTHSIDE BEHAVIORAL HEALTH - HOPE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ENGELHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-572-6916
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:143 INDUSTRIAL PARKWAY
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-1478
Mailing Address - Country:US
Mailing Address - Phone:434-572-6916
Mailing Address - Fax:434-374-3321
Practice Address - Street 1:154 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950-1703
Practice Address - Country:US
Practice Address - Phone:434-447-4008
Practice Address - Fax:434-447-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities