MEDICARE: HOPE, INC

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	302F00000X	Exclusive Provider Organization	L90474	MI

General Provider Information

NPI Number	:	1740478767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE, INC

Provider Business Mailing Address
First Line	:	4641 HOOVER AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-1121
Country	:	US
Telephone Number	:	937-268-2663
Fax Number	:	937-268-2219

Provider Business Practice Location Address
First Line	:	4641 HOOVER AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-1121
Country	:	US
Telephone Number	:	937-268-2663
Fax Number	:	937-268-2219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEROME PRITCHARD STEVENSON SR.
Credential	:	DMIN
Telephone Number	:	937-268-2663

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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Directions to “HOPE, INC ” Practice Location

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