Provider Demographics
NPI:1861439259
Name:HOPE RESIDENTIAL CARE SERVICES INC
Entity Type:Organization
Organization Name:HOPE RESIDENTIAL CARE SERVICES INC
Other - Org Name:DIABETIC SHOES & MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIGBE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:210-541-0056
Mailing Address - Street 1:5112 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3634
Mailing Address - Country:US
Mailing Address - Phone:210-541-0056
Mailing Address - Fax:210-541-8003
Practice Address - Street 1:5112 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3634
Practice Address - Country:US
Practice Address - Phone:210-541-0056
Practice Address - Fax:210-541-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0082273332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174958202Medicaid
TX174958201Medicaid
5480720001Medicare NSC