Healthcare Provider Details

I. General information

NPI: 1205229853
Provider Name (Legal Business Name): HOPE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 36TH ST. SE
GRAND RAPIDS MI
49501
US

IV. Provider business mailing address

PO BOX 141
GRAND RAPIDS MI
49501-0141
US

V. Phone/Fax

Practice location:
  • Phone: 616-248-5151
  • Fax: 616-243-2302
Mailing address:
  • Phone: 616-248-5151
  • Fax: 616-243-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberK162366585192
License Number StateMI

VIII. Authorized Official

Name: MRS. JAMIE MARIE KUPRIS
Title or Position: SUPPORTS COORDINATOR
Credential: LBSW, QIDP
Phone: 616-248-5151