Provider Demographics
NPI:1083809677
Name:PRIDE AND HOPE MINISTRY FAMILY SUPPORT
Entity Type:Organization
Organization Name:PRIDE AND HOPE MINISTRY FAMILY SUPPORT
Other - Org Name:PRIDE AND HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYROLL/BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:TRENACY
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-732-9494
Mailing Address - Street 1:25502 HWY 21
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426
Mailing Address - Country:US
Mailing Address - Phone:985-732-9494
Mailing Address - Fax:
Practice Address - Street 1:25502 HWY 21
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426
Practice Address - Country:US
Practice Address - Phone:985-732-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1625442Medicaid