Provider Demographics
NPI:1922286269
Name:ORA TREADWAY
Entity Type:Organization
Organization Name:ORA TREADWAY
Other - Org Name:HOPE RROVIDER CARE SERVICE,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ORA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TREADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-410-0900
Mailing Address - Street 1:808 N 31ST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3941
Mailing Address - Country:US
Mailing Address - Phone:318-410-0900
Mailing Address - Fax:318-410-0901
Practice Address - Street 1:808 N 31ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3941
Practice Address - Country:US
Practice Address - Phone:318-410-0900
Practice Address - Fax:318-410-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA10922251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1017191OtherEDA WAIVER