Provider Demographics
NPI:1043958507
Name:MICHIGAN CITY HOUSE OF HOPE
Entity type:Organization
Organization Name:MICHIGAN CITY HOUSE OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-229-4757
Mailing Address - Street 1:509 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3957
Mailing Address - Country:US
Mailing Address - Phone:219-229-4757
Mailing Address - Fax:
Practice Address - Street 1:1101 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3912
Practice Address - Country:US
Practice Address - Phone:219-229-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency