Provider Demographics
NPI:1538463914
Name:HOPE NETWORK
Entity Type:Organization
Organization Name:HOPE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KRZCIOK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:616-940-0040
Mailing Address - Street 1:1492 E BELTLINE AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4336
Mailing Address - Country:US
Mailing Address - Phone:616-940-0040
Mailing Address - Fax:616-940-1055
Practice Address - Street 1:1492 E BELTLINE AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4336
Practice Address - Country:US
Practice Address - Phone:616-940-0040
Practice Address - Fax:616-940-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703093649323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility