NPIMap

Organization Active NPI

Hope Haven Rebos United Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Madison, WI
National Provider Identifier
1407100514
Registry record updated Oct 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
1774 Issued in WI
Legal business name
HOPE HAVEN REBOS UNITED INC
Practice address
810 W Olin Ave
Madison, WI 53715-2142
Phone
(608) 255-5922
Fax
(608) 255-0340
NPI assigned
Oct 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Bruce Nicholas, MS.CSAC,ICS
Title
Director
Phone
(608) 441-0204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 1774 WI Primary

Addresses

Primary practice location

810 W Olin Ave
Madison, WI 53715-2142

Mailing address

810 W Olin Ave
Madison, WI 53715-2142
Phone (608) 255-5922

Other identifiers 1

IdentifierTypeStateIssuer
1417112780MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Marquette Chemical Dependency Service3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 4

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351468800000",
    "number": "1407100514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 W OLIN AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537152142",
            "telephone_number": "608-255-5922",
            "fax_number": "608-255-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 W OLIN AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537152142",
            "telephone_number": "608-255-5922",
            "fax_number": "608-255-0340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOPE HAVEN REBOS UNITED INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-29",
        "last_updated": "2012-10-29",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "608-441-0204",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS.CSAC,ICS"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "WI",
            "license": "1774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417112780",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.