Provider Demographics
NPI:1700825544
Name:NEW HOPE OF INDIANA, INC.
Entity Type:Organization
Organization Name:NEW HOPE OF INDIANA, INC.
Other - Org Name:GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAN DYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-338-4501
Mailing Address - Street 1:8450 N PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6621
Mailing Address - Country:US
Mailing Address - Phone:317-338-9600
Mailing Address - Fax:317-338-4585
Practice Address - Street 1:6068 MUNSEE LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-1331
Practice Address - Country:US
Practice Address - Phone:317-338-9600
Practice Address - Fax:317-338-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2538I001DE08310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100244840AMedicaid