Provider Demographics
NPI:1366151136
Name:IDEAL HOPE RENAISSANCE
Entity type:Organization
Organization Name:IDEAL HOPE RENAISSANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:EKECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-496-0518
Mailing Address - Street 1:1701 N LEE TREVINO DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4549
Mailing Address - Country:US
Mailing Address - Phone:915-262-4664
Mailing Address - Fax:
Practice Address - Street 1:1701 N LEE TREVINO DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4549
Practice Address - Country:US
Practice Address - Phone:915-262-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX803693584OtherCERTIFICATE OF FORMATION