Provider Demographics
NPI:1396176996
Name:HOLDING HOPE
Entity type:Organization
Organization Name:HOLDING HOPE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KOGELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-343-3033
Mailing Address - Street 1:1892 CONLEY RD
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48412-9772
Mailing Address - Country:US
Mailing Address - Phone:248-343-3033
Mailing Address - Fax:
Practice Address - Street 1:1892 CONLEY RD
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:MI
Practice Address - Zip Code:48412-9772
Practice Address - Country:US
Practice Address - Phone:248-343-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090145251B00000X, 251S00000X, 252Y00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801090145Medicaid