Healthcare Provider Details

I. General information

NPI: 1720335391
Provider Name (Legal Business Name): HOPE NETWORK REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 BLUE HERON CT
FENTON MI
48430-3269
US

IV. Provider business mailing address

2313 BLUE HERON CT
FENTON MI
48430-3269
US

V. Phone/Fax

Practice location:
  • Phone: 810-391-8246
  • Fax:
Mailing address:
  • Phone: 810-391-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDY HOWARD
Title or Position: THERAPEUTIC RECREATION SPECIALIST
Credential: CTRS
Phone: 517-332-1616