Basic Information
| Provider Information | |||||||||
| NPI: | 1639631138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOPE HOUSE RECOVERY HOUSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2615 STADIUM DR | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490081654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9989989998 | ||||||||
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| Practice Location | |||||||||
| Address1: | 131 S NOTTAWA ST | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490911736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693431651 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2019 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | LABADIE | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 2693431651 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY HEALING CENTERS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.