MEDICARE: ST. HOPE FOUNDATION, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1952078990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. HOPE FOUNDATION, INC

Provider Business Mailing Address
First Line	:	6200 SAVOY DR STE 540
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3338
Country	:	US
Telephone Number	:	713-778-1300
Fax Number	:	713-778-0827

Provider Business Practice Location Address
First Line	:	20320 NORTHWEST FWY STE 500
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77065-5644
Country	:	US
Telephone Number	:	713-778-1300
Fax Number	:	713-778-0827

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MS. TIMIKA COOPER
Credential	:
Telephone Number	:	713-778-1300

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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