Healthcare Provider Details

I. General information

NPI: 1255322962
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: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 PANTHER DR
NEW LEXINGTON OH
43764
US

IV. Provider business mailing address

1049 WESTERN AVE
CHILLICOTHEE OH
45601-1104
US

V. Phone/Fax

Practice location:
  • Phone: 740-342-4192
  • Fax: 740-342-4045
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