Healthcare Provider Details

I. General information

NPI: 1356695860
Provider Name (Legal Business Name): FAITH AND HOPE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON ST SUITE-A
MONROE LA
71201-6757
US

IV. Provider business mailing address

200 WASHINGTON ST SUITE-A
MONROE LA
71201-6757
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-6808
  • Fax: 318-388-6893
Mailing address:
  • Phone: 318-388-6808
  • Fax: 318-388-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NEAL W ANGRUM
Title or Position: OWNER
Credential:
Phone: 318-450-1478