Healthcare Provider Details

I. General information

NPI: 1063625515
Provider Name (Legal Business Name): HOPEWELL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 N NEWSTEAD AVE
SAINT LOUIS MO
63115-2534
US

IV. Provider business mailing address

218 GREENSHIRE LN
O FALLON MO
63368-8364
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-1770
  • Fax: 314-381-6796
Mailing address:
  • Phone: 636-379-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number36874
License Number StateMO

VIII. Authorized Official

Name: MRS. MARY LEE MONTGOMERY
Title or Position: CASE MANAGER
Credential: R.N.
Phone: 314-531-1770