Provider Demographics
NPI:1932365558
Name:PRIDE AND HOPE MINISTRY HOMEMAKER SERVICE
Entity Type:Organization
Organization Name:PRIDE AND HOPE MINISTRY HOMEMAKER SERVICE
Other - Org Name:PRIDE AND HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-732-9494
Mailing Address - Street 1:25502 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426-3898
Mailing Address - Country:US
Mailing Address - Phone:985-732-9494
Mailing Address - Fax:
Practice Address - Street 1:12 HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:MS
Practice Address - Zip Code:39478-9442
Practice Address - Country:US
Practice Address - Phone:601-736-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00325575385H00000X
MS385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00325575Medicaid