Provider Demographics
NPI:1619282845
Name:HANDS OF HOPE
Entity Type:Organization
Organization Name:HANDS OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATILLIUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-528-9749
Mailing Address - Street 1:2600 OLD AMY RD APT 22
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1893
Mailing Address - Country:US
Mailing Address - Phone:601-498-0446
Mailing Address - Fax:
Practice Address - Street 1:297 MAGNOLIA DR S STE B
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2744
Practice Address - Country:US
Practice Address - Phone:601-528-9749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty