Provider Demographics
NPI:1912333063
Name:FAITH AND HOPE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:FAITH AND HOPE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-683-1158
Mailing Address - Street 1:200 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6757
Mailing Address - Country:US
Mailing Address - Phone:225-683-1158
Mailing Address - Fax:225-683-1033
Practice Address - Street 1:9508 PLANK RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-3701
Practice Address - Country:US
Practice Address - Phone:225-683-1158
Practice Address - Fax:225-683-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health