Provider Demographics
NPI:1992443055
Name:BEACON OF HOPE RECOVERY LLC
Entity type:Organization
Organization Name:BEACON OF HOPE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, AGNP-C
Authorized Official - Phone:989-330-4484
Mailing Address - Street 1:17193 3 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MORLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49336-9572
Mailing Address - Country:US
Mailing Address - Phone:616-550-4816
Mailing Address - Fax:
Practice Address - Street 1:8681 VICKERYVILLE ROAD
Practice Address - Street 2:
Practice Address - City:FENWICK
Practice Address - State:MI
Practice Address - Zip Code:48834-4883
Practice Address - Country:US
Practice Address - Phone:989-330-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder