=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639178767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE MANOR, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2005
-----------------------------------------------------
Last Update Date | 12/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1665 M STREET
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-268-5361
-----------------------------------------------------
Fax | 559-268-8228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1665 M STREET
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-268-5361
-----------------------------------------------------
Fax | 559-268-8228
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT ADMINISTRATOR
-----------------------------------------------------
Name | JERRI L COLOMBINI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 559-268-5361
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BN1400X
-----------------------------------------------------
Taxonomy Name | Nursing Facility Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 040000200
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------