Basic Information
| Provider Information | |||||||||
| NPI: | 1538598115 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOPE NETWORK NEW PASSAGES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 N. GROESBECK | ||||||||
| Address2: | |||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866270024 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 N. GROESBECK HWY | ||||||||
| Address2: | |||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866270024 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRAGG-LOVE JOY | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5866270024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | 4704284704 | MI | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.