Basic Information
| Provider Information | |||||||||
| NPI: | 1649565615 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOPE NETWORK REHAB SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 GARFIELD AVE NW APT 1 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495045436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163255130 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1490 E BELTLINE AVE SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495064336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169400040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 06/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | WALLS | ||||||||
| AuthorizedOfficialFirstName: | LOVEY | ||||||||
| AuthorizedOfficialMiddleName: | JONELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | REHAB ASST | ||||||||
| AuthorizedOfficialTelephone: | 6163255130 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist |
No ID Information.