Healthcare Provider Details

I. General information

NPI: 1083809677
Provider Name (Legal Business Name): PRIDE AND HOPE MINISTRY FAMILY SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30208 HIGHWAY 21
ANGIE LA
70426-4360
US

IV. Provider business mailing address

25502 HWY 21
ANGIE LA
70426
US

V. Phone/Fax

Practice location:
  • Phone: 985-732-9494
  • Fax:
Mailing address:
  • Phone: 985-732-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY TRENACY KELLY
Title or Position: PAYROLL/BILLING ADMINISTRATOR
Credential:
Phone: 985-732-9494