Healthcare Provider Details

I. General information

NPI: 1154562544
Provider Name (Legal Business Name): HOPEWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9637 STATE ROUTE 534
MIDDLEFIELD OH
44062-9516
US

IV. Provider business mailing address

9637 STATE ROUTE 534
MIDDLEFIELD OH
44062
US

V. Phone/Fax

Practice location:
  • Phone: 440-426-2000
  • Fax: 440-693-4168
Mailing address:
  • Phone: 440-426-2000
  • Fax: 440-426-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number488
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID SHUTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 440-426-2000