Healthcare Provider Details

I. General information

NPI: 1669463360
Provider Name (Legal Business Name): HOPEWELL HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30381 CHIEFTAIN DRIVE
LOGAN OH
43138-1013
US

IV. Provider business mailing address

1049 WESTERN AVE
CHILLICOTHEE OH
45601-1104
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-2555
  • Fax: 740-380-3750
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateOH

VIII. Authorized Official

Name: MARK A BRIDENBAUGH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 740-773-4366