Basic Information
| Provider Information | |||||||||
| NPI: | 1639178767 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOPE MANOR, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1665 M STREET | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592685361 | ||||||||
| FaxNumber: | 5592688228 | ||||||||
| Practice Location | |||||||||
| Address1: | 1665 M STREET | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592685361 | ||||||||
| FaxNumber: | 5592688228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 12/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | COLOMBINI | ||||||||
| AuthorizedOfficialFirstName: | JERRI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5592685361 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BN1400X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 314000000X | 040000200 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0610935 | 05 | CA | MEDICAID | ZZRO5626G | 05 | CA | MEDICAID |