Healthcare Provider Details

I. General information

NPI: 1598065864
Provider Name (Legal Business Name): HOPE MEDIVAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9229 THOMAS AVE
BRIDGEVIEW IL
60455-2143
US

IV. Provider business mailing address

9229 THOMAS AVE
BRIDGEVIEW IL
60455-2143
US

V. Phone/Fax

Practice location:
  • Phone: 708-430-3922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARYAM SALAH
Title or Position: PRESIDENT
Credential:
Phone: 708-430-3922