Provider Demographics
NPI:1104204429
Name:HOPE NETWORK WEST MICHIGAN
Entity Type:Organization
Organization Name:HOPE NETWORK WEST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:616-301-8000
Mailing Address - Street 1:PO BOX 890, 3075 ORCHARD VISTA
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49518-0890
Mailing Address - Country:US
Mailing Address - Phone:616-301-8000
Mailing Address - Fax:616-301-8010
Practice Address - Street 1:795 36TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-2319
Practice Address - Country:US
Practice Address - Phone:616-301-8000
Practice Address - Fax:616-301-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P46680Medicare PIN