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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
1103K00000XBehavior Analyst
2103T00000XPsychologist
3103TC0700XClinical Psychologist
4103TH0100XHealth Service Psychologist
5106E00000XAssistant Behavior Analyst
6106S00000XBehavior Technician
7225100000XPhysical Therapist
82251P0200XPediatric Physical Therapist
9225X00000XOccupational Therapist
10225XP0200XPediatric Occupational Therapist
11235Z00000XSpeech-Language Pathologist
122084P0804XChild & Adolescent Psychiatry Physician

General Provider Information

NPI Number : 1952880049
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 : 4000 SMITHTOWN RD STE 200
Second Line :
City : SUWANEE
State : GA
Zip : 30024-6560
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 : 08/09/2018
Last Update Date : 08/09/2018

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Directions to “HOPEBRIDGE, LLC ” Practice Location

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