Provider Demographics
NPI:1710376017
Name:HOPE SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:HOPE SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-870-5164
Mailing Address - Street 1:16972 W DOUNREAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-2995
Mailing Address - Country:US
Mailing Address - Phone:936-870-5164
Mailing Address - Fax:936-588-0428
Practice Address - Street 1:16972 W DOUNREAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-2995
Practice Address - Country:US
Practice Address - Phone:936-870-5164
Practice Address - Fax:936-588-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based