Healthcare Provider Details

I. General information

NPI: 1265772685
Provider Name (Legal Business Name): FAITH AND HOPE INDEPENDENT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 THATCHER LN
MONROE LA
71203-6516
US

IV. Provider business mailing address

232 MARKET ST BLDG K 2ND LEVEL STE. 208
FLOWOOD MS
39232-3339
US

V. Phone/Fax

Practice location:
  • Phone: 318-450-1478
  • Fax: 318-388-6893
Mailing address:
  • Phone: 601-951-5667
  • Fax: 601-914-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KULMORIS JOINER
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 601-807-5496