Basic Information
| Provider Information | |||||||||
| NPI: | 1669463360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOPEWELL HEALTH CENTERS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1049 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456011104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407734366 | ||||||||
| FaxNumber: | 7407757855 | ||||||||
| Practice Location | |||||||||
| Address1: | 30381 CHIEFTAIN DRIVE | ||||||||
| Address2: | |||||||||
| City: | LOGAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431381013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403852555 | ||||||||
| FaxNumber: | 7403803750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 12/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | BRIDENBAUGH | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7407734366 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOPEWELL HEALTH CENTERS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 2391746 | 05 | OH | MEDICAID |