Healthcare Provider Details

I. General information

NPI: 1629113089
Provider Name (Legal Business Name): HOPE NETWORK BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 BROADWAY AVE NW
GRAND RAPIDS MI
49504-3207
US

IV. Provider business mailing address

1242 BROADWAY AVE NW
GRAND RAPIDS MI
49504-3207
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-7519
  • Fax:
Mailing address:
  • Phone: 616-458-7519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number4
License Number StateMI

VIII. Authorized Official

Name: MISS DARCY JEAN MILLIS
Title or Position: CASE MANAGER
Credential: B.S.P.A
Phone: 616-774-8789