Provider Demographics
NPI:1972047355
Name:HANOVER HOME CARE, INC.
Entity Type:Organization
Organization Name:HANOVER HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEDE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OBASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-498-6103
Mailing Address - Street 1:305 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1939
Mailing Address - Country:US
Mailing Address - Phone:269-948-9057
Mailing Address - Fax:
Practice Address - Street 1:305 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1939
Practice Address - Country:US
Practice Address - Phone:269-948-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS1303773153104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness