| Organization Name: | HOPE CLINIC LLC |
| NPI Number: | 1144299470 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ASANTE WAGNER (CREDENTIALING SPECIALIST) |
| Mailing Address: | 110 Executive Pkwy Moncks Corner |
| State: | SC US |
| Postal Code: | 294613930 |
| Phone Number: | 8438999099 |
| Fax Number: | 8883185567 |
| NPI Enumeration Date: | 03/17/2006 |
| NPI Last Update Date: | 05/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332900000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Non-Pharmacy Dispensing Site |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |