1528253119 NPI number — PRIDE AND HOPE MINISTRY HOMEMAKER SERVICES

Table of content: (NPI 1528253119)

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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