Provider Demographics
NPI:1639178767
Name:HOPE MANOR, INC.
Entity Type:Organization
Organization Name:HOPE MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLOMBINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-268-5361
Mailing Address - Street 1:1665 M STREET
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721
Mailing Address - Country:US
Mailing Address - Phone:559-268-5361
Mailing Address - Fax:559-268-8228
Practice Address - Street 1:1665 M STREET
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721
Practice Address - Country:US
Practice Address - Phone:559-268-5361
Practice Address - Fax:559-268-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000200314000000X
332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0610935Medicaid
CAZZRO5626GMedicaid
CA0610935Medicaid
CA5215090001Medicare NSC
CAZZRO5626GMedicaid