Provider Demographics
NPI:1871044214
Name:ABUNDANCE OF HOPE
Entity Type:Organization
Organization Name:ABUNDANCE OF HOPE
Other - Org Name:ABUNDANCE OF HOPE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUZANN
Authorized Official - Last Name:VANDERBENT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-260-0993
Mailing Address - Street 1:186 S RIVER AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-2848
Mailing Address - Country:US
Mailing Address - Phone:616-260-0993
Mailing Address - Fax:
Practice Address - Street 1:186 S RIVER AVE STE 5
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2848
Practice Address - Country:US
Practice Address - Phone:616-260-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010855501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty