Organization Active NPI

Hope House of Itasca County, Inc.

  • Substance Abuse Rehabilitation Facility
  • Grand Rapids, MN
National Provider Identifier
1851496368
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1002621-2 Issued in MN
Legal business name
HOPE HOUSE OF ITASCA COUNTY, INC.
Practice address
2086 Ridgeway Dr
Grand Rapids, MN 55744-4421
Phone
(218) 327-9944
Fax
(218) 327-9375
NPI assigned
Sep 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Authorized official

Name
Ms. Susan Lynn Marchel
Title
Executive Director
Phone
(218) 327-9944

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Abuse Rehabilitation Facility 324500000X 1002621-2 MN Primary

Addresses

Primary practice location

2086 Ridgeway Dr
Grand Rapids, MN 55744-4421

Mailing address

2086 Ridgeway Dr
Grand Rapids, MN 55744-4421
Phone (218) 327-9944

Other identifiers 1

IdentifierTypeStateIssuer
642634400MedicaidMN

Other names 1

  • Pear Lake Women's Facility Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2263700Hope House of Itasca County (Men'S Program)2086 Ridgeway Drive, Grand Rapids, MN 55744Certificate of waiverJul 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Hope House of Itasca County Inc3 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.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617062400000",
    "number": "1851496368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2086 RIDGEWAY DR",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557444421",
            "telephone_number": "218-327-9944",
            "fax_number": "218-327-9375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2086 RIDGEWAY DR",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557444421",
            "telephone_number": "218-327-9944",
            "fax_number": "218-327-9375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOPE HOUSE OF ITASCA COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A",
        "authorized_official_last_name": "MARCHEL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "218-327-9944",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1002621-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "642634400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pear Lake Women's Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pear Lake Women's Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.