Healthcare Provider Details

I. General information

NPI: 1669144705
Provider Name (Legal Business Name): HOPEWELL HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOLLY LN
GALLIPOLIS OH
45631-1672
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-794-6019
  • Fax: 740-794-6022
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-773-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARK BRIDENBAUGH
Title or Position: CEO
Credential:
Phone: 740-773-4366