MEDICARE: HOPE BRIDGE LIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1306792767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE BRIDGE LIVING LLC

Provider Business Mailing Address
First Line	:	1088 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-9716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1088 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-9716
Country	:	US
Telephone Number	:	801-300-8477
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALFRED RUBYUTSA
Credential	:
Telephone Number	:	801-300-8477

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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