Healthcare Provider Details

I. General information

NPI: 1588354740
Provider Name (Legal Business Name): HOPEWELL HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 TYREE BLVD
RACINE OH
45771-5008
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-444-5247
  • Fax: 740-444-5249
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-773-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

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