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General NPI Number Information
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NPI Number | 1538463914
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Entity Type | Organization
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Legal Business Name | HOPE NETWORK
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 1492 E BELTLINE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4336
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Country | US
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Telephone | 616-940-0040
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Fax | 616-940-1055
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Provider Business Mailing Address
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Address Line | 1492 E BELTLINE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4336
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Country | US
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Telephone | 616-940-0040
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Fax | 616-940-1055
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Authorized Official
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Title or Position | PROGRAM NURSE
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Name | MISS LORI JO KRZCIOK
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Credential | LPN
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Telephone | 616-940-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 4703093649
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License Number State | MI
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