Healthcare Provider Details

I. General information

NPI: 1194073908
Provider Name (Legal Business Name): HOPE NETWORK REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 EAST BELTLINE
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

1490 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4336
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-0440
  • Fax:
Mailing address:
  • Phone:
  • 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: PHILLIP HERNANDEZ
Title or Position: RECREATION AIDE
Credential:
Phone: 616-940-0040