Organization
IDEAL HOPE RENAISSANCE
Active
Other names
IDEAL HOPE RENAISSANCE
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH O EKECHUKWU (EXECUTIVE DIRECTOR)
(215) 496-0518
Entity
Organization
Contact information
Practice address
1701 N LEE TREVINO DR STE A, EL PASO, TX 79936-4549
(915) 262-4664
Mailing address
1701 N LEE TREVINO DR STE A, EL PASO, TX 79936-4549
(915) 262-4664
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
803693584
CERTIFICATE OF FORMATION
TX
Enumeration date
11/21/2022
Last updated
11/21/2022
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