Healthcare Provider Details

I. General information

NPI: 1578489332
Provider Name (Legal Business Name): HOPE FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 S TELULAH AVE
APPLETON WI
54915-3804
US

IV. Provider business mailing address

1619 S TELULAH AVE # A
APPLETON WI
54915-3804
US

V. Phone/Fax

Practice location:
  • Phone: 701-540-3617
  • Fax:
Mailing address:
  • Phone: 701-540-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MASOMO SYLVAIN RUGAMA
Title or Position: CEO
Credential:
Phone: 701-540-3617