Basic Information
| Provider Information | |||||||||
| NPI: | 1235514969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOPEWELL MENTAL HEALTH SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1186 | ||||||||
| Address2: | |||||||||
| City: | WORTHINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430851186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147960338 | ||||||||
| FaxNumber: | 6148905485 | ||||||||
| Practice Location | |||||||||
| Address1: | 7625 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430169649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147171800 | ||||||||
| FaxNumber: | 6147171801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2015 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6145802500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0138900 | 05 | OH | MEDICAID | H404550 | 01 | OH | MEDICARE | OTHER |