Provider Demographics
NPI:1174679872
Name:NEW HOPE HOME MEDICAL
Entity Type:Organization
Organization Name:NEW HOPE HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-826-5566
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-0826
Mailing Address - Country:US
Mailing Address - Phone:912-826-5566
Mailing Address - Fax:912-826-6124
Practice Address - Street 1:171 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5469
Practice Address - Country:US
Practice Address - Phone:912-826-5566
Practice Address - Fax:912-826-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2397332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4870390001Medicare ID - Type Unspecified