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General NPI Number Information
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NPI Number | 1063625515
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Entity Type | Organization
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Legal Business Name | HOPEWELL CENTER
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4411 N NEWSTEAD AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63115-2534
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Country | US
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Telephone | 314-531-1770
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Fax | 314-381-6796
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Provider Business Mailing Address
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Address Line | 218 GREENSHIRE LN
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City | O FALLON
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State | MO
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Zip | 63368-8364
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Country | US
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Telephone | 636-379-7727
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | MRS. MARY LEE MONTGOMERY
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Credential | R.N.
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Telephone | 314-531-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 36874
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License Number State | MO
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