Healthcare Provider Details

I. General information

NPI: 1750990438
Provider Name (Legal Business Name): HOPE419, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2267 VILLAGE MALL DR UNIT 2
ONTARIO OH
44906-1369
US

IV. Provider business mailing address

2267 VILLAGE MALL DR UNIT 2
ONTARIO OH
44906-1369
US

V. Phone/Fax

Practice location:
  • Phone: 419-951-2020
  • Fax:
Mailing address:
  • Phone: 419-951-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHANNA S. WILSON
Title or Position: CEO
Credential:
Phone: 330-328-3291