Healthcare Provider Details

I. General information

NPI: 1952152936
Provider Name (Legal Business Name): HOPE CLINICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 SOUTH ST
WRENTHAM MA
02093-1565
US

IV. Provider business mailing address

5250 6TH STREET FRONTAGE RD E
SPRINGFIELD IL
62703-5128
US

V. Phone/Fax

Practice location:
  • Phone: 833-585-5437
  • Fax:
Mailing address:
  • Phone: 217-553-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CLINT PAUL
Title or Position: PRESIDENT
Credential:
Phone: 217-585-5437