Provider Demographics
NPI:1689130684
Name:HOUSE OF HOPE, INC.
Entity type:Organization
Organization Name:HOUSE OF HOPE, INC.
Other - Org Name:
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:56002-0291
Mailing Address - Country:US
Mailing Address - Phone:507-385-7600
Mailing Address - Fax:507-720-6929
Practice Address - Street 1:299 JOHNSON AVE SW STE 280
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2539
Practice Address - Country:US
Practice Address - Phone:507-385-8774
Practice Address - Fax:507-835-4821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF HOPE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-14
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1689130684OtherNPI # - WASECA