Healthcare Provider Details

I. General information

NPI: 1285105650
Provider Name (Legal Business Name): HOME WITH HOPE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 FERRY ST
LAFAYETTE IN
47901-1532
US

IV. Provider business mailing address

1119 FERRY ST
LAFAYETTE IN
47901-1532
US

V. Phone/Fax

Practice location:
  • Phone: 765-807-0009
  • Fax: 765-807-0030
Mailing address:
  • Phone: 765-807-0009
  • Fax: 765-807-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: R BRUCE SCHUCKER
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 765-807-0009