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NPI Code Detail

MEDICARE: HOPEBRIDGE, LLC

MEDICARE: HOPEBRIDGE, LLC
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
1103TC0700XClinical Psychologist
2106E00000XAssistant Behavior Analyst
3106S00000XBehavior Technician
4225100000XPhysical Therapist
5225X00000XOccupational Therapist
6235Z00000XSpeech-Language Pathologist
7103K00000XBehavior Analyst
8103T00000XPsychologist
92084P0804XChild & Adolescent Psychiatry Physician

General Provider Information

NPI Number : 1790245173
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPEBRIDGE, LLC
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2651 DALLAS HWY SW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-2541
Country : US
Telephone Number : 855-324-0885
Fax Number :
Authorized Official
Title or Position : INSURANCE & CREDENTIALING MANAGER
Name : ANGIE GRAFF
Credential :
Telephone Number : 317-376-8336
Provider Enumeration Date : 03/22/2019
Last Update Date : 03/22/2019

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Directions to “HOPEBRIDGE, LLC ” Practice Location

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