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General NPI Number Information
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NPI Number | 1710587910
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Entity Type | Organization
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Legal Business Name | HOPE RECOVERY KOKOMO, LLC
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1236 N. WABASH AVE
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City | KOKOMO
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State | IN
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Zip | 46901
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Country | US
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Telephone | 310-741-7199
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Fax |
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Provider Business Mailing Address
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Address Line | 302 S REED RD
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City | KOKOMO
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State | IN
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Zip | 46901-4900
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Country | US
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Telephone | 765-780-7689
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID CHRISTENSON
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Credential |
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Telephone | 317-437-7040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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