Provider Demographics
NPI:1215071147
Name:PRIDE AND HOPE MINISTRY FAMILY SUPPORT
Entity type:Organization
Organization Name:PRIDE AND HOPE MINISTRY FAMILY SUPPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-732-9494
Mailing Address - Street 1:25502 HWY 21
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426
Mailing Address - Country:US
Mailing Address - Phone:985-732-9494
Mailing Address - Fax:985-732-9615
Practice Address - Street 1:30208 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426-4360
Practice Address - Country:US
Practice Address - Phone:985-732-9494
Practice Address - Fax:985-261-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11896251F00000X
LA11891251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1625256Medicaid