Healthcare Provider Details

I. General information

NPI: 1831365758
Provider Name (Legal Business Name): HOPE-FACS L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 E 84TH PL
MERRILLVILLE IN
46410-6451
US

IV. Provider business mailing address

1471 E 84TH PL
MERRILLVILLE IN
46410-6451
US

V. Phone/Fax

Practice location:
  • Phone: 219-345-5611
  • Fax: 219-345-5140
Mailing address:
  • Phone: 219-345-5611
  • Fax: 219-345-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01035167A
License Number StateIN

VIII. Authorized Official

Name: DR. ARSENIO S FAVOR
Title or Position: PRESIDENT
Credential: MD
Phone: 219-345-5611