MEDICARE: THE FAMILY CENTER OF HOPE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1124316039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY CENTER OF HOPE, INC.

Provider Business Mailing Address
First Line	:	4422 SAINT CHARLES AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-4830
Country	:	US
Telephone Number	:	505-891-3264
Fax Number	:	504-891-1172

Provider Business Practice Location Address
First Line	:	4422 SAINT CHARLES AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-4830
Country	:	US
Telephone Number	:	505-891-3264
Fax Number	:	504-891-1172

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. PAT G WATSON
Credential	:	LMSW
Telephone Number	:	504-259-7642

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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