Basic Information
| Provider Information | |||||||||
| NPI: | 1699010348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOPEWELL HEALTH CENTERS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405945045 | ||||||||
| FaxNumber: | 7405945642 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405945045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | BRIDENBAUGH | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7407734366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 0079719 | 05 | OH | MEDICAID |