Provider Demographics
NPI:1013590819
Name:FIELD OF HOPE COMMUNITY CAMPUS, INC.
Entity Type:Organization
Organization Name:FIELD OF HOPE COMMUNITY CAMPUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-245-3051
Mailing Address - Street 1:11821 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-9009
Mailing Address - Country:US
Mailing Address - Phone:740-245-3051
Mailing Address - Fax:740-245-3052
Practice Address - Street 1:11821 STATE ROUTE 160
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686-9009
Practice Address - Country:US
Practice Address - Phone:740-245-3051
Practice Address - Fax:740-245-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145313Medicaid