Provider Demographics
NPI:1013434182
Name:BENJAMIN'S HOPE
Entity Type:Organization
Organization Name:BENJAMIN'S HOPE
Other - Org Name:BENJAMIN'S HOPE LIFE ENRICHMENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPPENGA
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:616-399-6293
Mailing Address - Street 1:15468 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6120
Mailing Address - Country:US
Mailing Address - Phone:616-399-6293
Mailing Address - Fax:
Practice Address - Street 1:15468 RILEY ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-6120
Practice Address - Country:US
Practice Address - Phone:616-399-6293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health