Healthcare Provider Details

I. General information

NPI: 1104128602
Provider Name (Legal Business Name): HOPE NETWORK BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 36TH STREET
GRAND RAPIDS MI
49512
US

IV. Provider business mailing address

3075 ORCHARD VISTA DR SE
GRAND RAPIDS MI
49546-7069
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2522
  • Fax:
Mailing address:
  • Phone: 616-301-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY BECKER
Title or Position: COO
Credential:
Phone: 616-301-8000