Provider Demographics
NPI:1902008089
Name:HOPE HAVEN AREA DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:HOPE HAVEN AREA DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-237-1308
Mailing Address - Street 1:828 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4921
Mailing Address - Country:US
Mailing Address - Phone:319-754-4689
Mailing Address - Fax:319-754-0045
Practice Address - Street 1:828 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601
Practice Address - Country:US
Practice Address - Phone:319-754-4689
Practice Address - Fax:319-754-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0763912Medicaid