Healthcare Provider Details

I. General information

NPI: 1669995221
Provider Name (Legal Business Name): EMERGING HOPE FAMILY STRENGTHENING PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EMERALD DR
KALAMAZOO MI
49001-7919
US

IV. Provider business mailing address

PO BOX 224
PORTAGE MI
49081-0224
US

V. Phone/Fax

Practice location:
  • Phone: 269-205-3356
  • Fax:
Mailing address:
  • Phone: 269-205-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801091924
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6801091924
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6801091924
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number6801091924
License Number StateMI

VIII. Authorized Official

Name: DR. PAMELA REGINA ROBINSON
Title or Position: CO-DIRECTOR/FOUNDER
Credential: LLMSW, MDIV, DMIN
Phone: 269-205-3356