Healthcare Provider Details

I. General information

NPI: 1457780314
Provider Name (Legal Business Name): HOPE NETWORK REHABILITATION SERVICESQ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 BROOKE DRIVE
KALAMAZOO MI
49048
US

IV. Provider business mailing address

2236 BROOK DR
KALAMAZOO MI
49048-2806
US

V. Phone/Fax

Practice location:
  • Phone: 269-492-7205
  • Fax:
Mailing address:
  • Phone: 296-492-7205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: MISS ALEXA ANN PAYNE
Title or Position: INDEPENDENT LIVING INSTRUCTOR
Credential:
Phone: 269-492-7205