MEDICARE: HOPE RUSH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	79096	ND

General Provider Information

NPI Number	:	1063539310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOPE RUSH

Provider Business Mailing Address
First Line	:	1237 W DIVIDE AVE
Second Line	:	STE 5
City	:	BISMARCK
State	:	ND
Zip	:	58501-1220
Country	:	US
Telephone Number	:	701-328-8859
Fax Number	:	701-328-8900

Provider Business Practice Location Address
First Line	:	1237 W DIVIDE AVE
Second Line	:	STE 5
City	:	BISMARCK
State	:	ND
Zip	:	58501-1220
Country	:	US
Telephone Number	:	701-328-8859
Fax Number	:	701-328-8900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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Directions to “ HOPE RUSH ” Practice Location

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