Healthcare Provider Details

I. General information

NPI: 1639178767
Provider Name (Legal Business Name): HOPE MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 M STREET
FRESNO CA
93721
US

IV. Provider business mailing address

1665 M STREET
FRESNO CA
93721
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-5361
  • Fax: 559-268-8228
Mailing address:
  • Phone: 559-268-5361
  • Fax: 559-268-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number040000200
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JERRI L COLOMBINI
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 559-268-5361