Provider Demographics
NPI:1356661300
Name:HOPE MANOR
Entity Type:Organization
Organization Name:HOPE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KERNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:337-363-4521
Mailing Address - Street 1:2683 VIDRINE RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-8505
Mailing Address - Country:US
Mailing Address - Phone:337-363-4521
Mailing Address - Fax:
Practice Address - Street 1:2683 VIDRINE RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-8505
Practice Address - Country:US
Practice Address - Phone:337-363-4521
Practice Address - Fax:337-363-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA554047302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1566039Medicaid
LA1175561Medicaid