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General NPI Number Information
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NPI Number | 1972047355
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Entity Type | Organization
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Legal Business Name | HANOVER HOME CARE, INC.
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 305 S HANOVER ST
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City | HASTINGS
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State | MI
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Zip | 49058-1939
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Country | US
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Telephone | 269-948-9057
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Fax |
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Provider Business Mailing Address
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Address Line | 305 S HANOVER ST
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City | HASTINGS
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State | MI
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Zip | 49058-1939
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Country | US
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Telephone | 269-948-9057
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BEDE E OBASI
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Credential |
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Telephone | 616-498-6103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AS130377315
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License Number State | MI
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