Provider Demographics
NPI:1881692192
Name:HOUSE OF HOPE, INC.
Entity type:Organization
Organization Name:HOUSE OF HOPE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-385-7611
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002
Mailing Address - Country:US
Mailing Address - Phone:507-385-7600
Mailing Address - Fax:507-385-3929
Practice Address - Street 1:12 CIVIC CENTER PLAZA, SUITE 2116
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-385-8774
Practice Address - Fax:507-345-1895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF HOPE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-11
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN811014-1OPCD261QR0405X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1881692192Medicaid
MN121255OtherUCARE PROVIDER
MN8179ADOtherBLUE CROSS BLUE SHIELD
MN07AFAOtherDAANES FACILITY CODE