Healthcare Provider Details

I. General information

NPI: 1619217353
Provider Name (Legal Business Name): HOPE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2013
Last Update Date: 02/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 LEONARD ST NE
GRAND RAPIDS MI
49503-1129
US

IV. Provider business mailing address

2301 VALLEYWOOD DR SE APT G1
GRAND RAPIDS MI
49546-7745
US

V. Phone/Fax

Practice location:
  • Phone: 616-454-4777
  • Fax:
Mailing address:
  • Phone: 517-648-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number6801087737
License Number StateMI

VIII. Authorized Official

Name: MRS. JESSICA LYNN SIMPSON
Title or Position: CRISIS SOCIAL WORKER
Credential: LMSW
Phone: 517-648-4659