Provider Demographics
NPI:1710985114
Name:HOPEALLIANZ INC
Entity Type:Organization
Organization Name:HOPEALLIANZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:L FRIESEN
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-546-6624
Mailing Address - Street 1:4205 LANCASTER LN N
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1700
Mailing Address - Country:US
Mailing Address - Phone:763-546-6624
Mailing Address - Fax:763-332-5006
Practice Address - Street 1:4205 LANCASTER LN N
Practice Address - Street 2:SUITE 111
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1700
Practice Address - Country:US
Practice Address - Phone:763-546-6624
Practice Address - Fax:763-332-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN475522700Medicaid
MN475522700Medicaid