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NPI Code Detail

MEDICARE: HOPEBRIDGE, LLC

MEDICARE: HOPEBRIDGE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2103T00000XPsychologist
3103TC0700XClinical Psychologist
4106E00000XAssistant Behavior Analyst
5106S00000XBehavior Technician
6225100000XPhysical Therapist
7225X00000XOccupational Therapist
8235Z00000XSpeech-Language Pathologist
92084P0804XChild & Adolescent Psychiatry Physician

General Provider Information

NPI Number : 1922586486
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPEBRIDGE, LLC
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1455 OLD ALABAMA RD STE 195
Second Line :
City : ROSWELL
State : GA
Zip : 30076-2129
Country : US
Telephone Number : 855-324-0885
Fax Number :
Authorized Official
Title or Position : INSURANCE & CREDENTIALING MANAGER
Name : ANGIE GRAFF
Credential :
Telephone Number : 317-376-8336
Provider Enumeration Date : 08/06/2018
Last Update Date : 05/01/2020

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Directions to “HOPEBRIDGE, LLC ” Practice Location

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