Healthcare Provider Details

I. General information

NPI: 1831651348
Provider Name (Legal Business Name): STAR OF HOPE RECOVERY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S 4TH ST
NILES MI
49120-3204
US

IV. Provider business mailing address

2615 STADIUM DR
KALAMAZOO MI
49008-1654
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-1651
  • Fax:
Mailing address:
  • Phone: 998-998-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN W LABADIE
Title or Position: BILLING ANALYST
Credential:
Phone: 269-343-1651