=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396601696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPEWELL SOUTHEAST, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 OAKFIELD DR
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-513-9097
-----------------------------------------------------
Fax | 813-513-9334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1405 NW 6TH ST STE 120
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32601-4021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-240-1259
-----------------------------------------------------
Fax | 352-519-0577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | CHRISTOPHER DAVID BULLOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-362-4132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------