Provider Demographics
NPI:1811266398
Name:HOPE HEALTHCARE OF WEST TENNESSEE
Entity type:Organization
Organization Name:HOPE HEALTHCARE OF WEST TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-661-9163
Mailing Address - Street 1:21 SECURITY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3626
Mailing Address - Country:US
Mailing Address - Phone:731-661-9163
Mailing Address - Fax:731-664-9916
Practice Address - Street 1:21 SECURITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3626
Practice Address - Country:US
Practice Address - Phone:731-661-9163
Practice Address - Fax:731-664-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44D2021554OtherCLIA ID NUMBER