Hope Shores Linden, LLC

Key facts

NPI

1063252963

Entity type

Organization (NPI type 2)

Primary specialty

Assisted Living Facility (Behavioral Disturbances) 3104A0630X

Legal business name

HOPE SHORES LINDEN, LLC

Practice address

12237 N Linden Rd
Clio, MI 48420-8205

Phone

(810) 640-8228

NPI assigned

May 29, 2024

Organization subpart

No

Authorized official

Name

Ryan Wickson

Title

Ceo

Phone

(810) 964-0412

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Antonio Coleman Community Health Worker · Burton, MI · NPI 1700747706
  NPD

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 29, 2024.

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1063252963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13224 LAKE SHORE DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12237 N LINDEN RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484208205",
            "telephone_number": "810-640-8228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOPE SHORES LINDEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "WICKSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "810-964-0412"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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