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General NPI Number Information
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NPI Number | 1750990438
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Entity Type | Organization
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Legal Business Name | HOPE419, LLC
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 2267 VILLAGE MALL DR UNIT 2
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City | ONTARIO
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State | OH
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Zip | 44906-1369
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Country | US
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Telephone | 419-951-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 2267 VILLAGE MALL DR UNIT 2
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City | ONTARIO
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State | OH
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Zip | 44906-1369
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Country | US
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Telephone | 419-951-2020
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHANNA S. WILSON
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Credential |
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Telephone | 330-328-3291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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