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General NPI Number Information
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NPI Number | 1033469192
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Entity Type | Organization
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Legal Business Name | HOPE AMBULANCE LLC
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 1548 OLD HWY 5 SOUTH
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City | ELLIJAY
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State | GA
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Zip | 30540-5938
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Country | US
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Telephone | 866-213-1275
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Fax | 706-273-7476
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Provider Business Mailing Address
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Address Line | P.O. BOX 1725
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City | ELLIJAY
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State | GA
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Zip | 30540-0033
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Country | US
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Telephone | 886-213-1275
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Fax | 706-273-7476
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Authorized Official
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Title or Position | OWNER
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Name | MR. JACKIE ELLINGTON
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Credential | EMT-I
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Telephone | 706-889-8199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 061-05
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License Number State | GA
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