1528253119 NPI number — PRIDE AND HOPE MINISTRY HOMEMAKER SERVICES

Table of content: ANNIE ELIZABETH LEE MD (NPI 1376347492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528253119 NPI number — PRIDE AND HOPE MINISTRY HOMEMAKER SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIDE AND HOPE MINISTRY HOMEMAKER SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528253119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 HWY 35 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY HOOK
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-732-9494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30208 HIGHWAY 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANGIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70426-4360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-732-9494
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
TRENACY
Authorized Official Title or Position:
PAYROLL/BILLING ADMINISTRATOR
Authorized Official Telephone Number:
985-732-9494

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01581776 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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