Provider Demographics
NPI:1720335391
Name:HOPE NETWORK REHABILITATION
Entity Type:Organization
Organization Name:HOPE NETWORK REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC RECREATION SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:517-332-1616
Mailing Address - Street 1:2313 BLUE HERON CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3269
Mailing Address - Country:US
Mailing Address - Phone:810-391-8246
Mailing Address - Fax:
Practice Address - Street 1:2313 BLUE HERON CT
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3269
Practice Address - Country:US
Practice Address - Phone:810-391-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities