Basic Information
| Provider Information | |||||||||
| NPI: | 1376625889 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOPE MANOR INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1665 M ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592685361 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1665 M ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592685361 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EPPERSON | ||||||||
| AuthorizedOfficialFirstName: | LUCILLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5592685361 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3140N1450X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric |
ID Information
| ID | Type | State | Issuer | Description | ZZR05626G | 05 | CA | MEDICAID |