Healthcare Provider Details

I. General information

NPI: 1578740767
Provider Name (Legal Business Name): HOPE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GAYVEN DR
PINEVILLE LA
71405-4901
US

IV. Provider business mailing address

103 GAYVEN DR
PINEVILLE LA
71405-4901
US

V. Phone/Fax

Practice location:
  • Phone: 318-640-0616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY WENKEL
Title or Position: REGISTERED AGENT, MEMBER
Credential:
Phone: 318-640-0616