MEDICARE: HOPEWELL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	36874	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36874	OTHER	MO	R.N.

General Provider Information

NPI Number	:	1063625515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPEWELL CENTER

Provider Business Mailing Address
First Line	:	218 GREENSHIRE LN
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-8364
Country	:	US
Telephone Number	:	636-379-7727
Fax Number	:

Provider Business Practice Location Address
First Line	:	4411 N NEWSTEAD AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2534
Country	:	US
Telephone Number	:	314-531-1770
Fax Number	:	314-381-6796

Authorized Official
Title or Position	:	CASE MANAGER
Name	:	MRS. MARY LEE MONTGOMERY
Credential	:	R.N.
Telephone Number	:	314-531-1770

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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Directions to “HOPEWELL CENTER ” Practice Location

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