Provider Demographics
NPI:1093343071
Name:HOPE VILLAGE WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:HOPE VILLAGE WELLNESS CENTER PLLC
Other - Org Name:BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWUREH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-467-5207
Mailing Address - Street 1:12915 JONES MALTSBERGER RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4255
Mailing Address - Country:US
Mailing Address - Phone:210-687-3526
Mailing Address - Fax:210-467-5207
Practice Address - Street 1:12915 JONES MALTSBERGER RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4255
Practice Address - Country:US
Practice Address - Phone:210-687-3526
Practice Address - Fax:210-610-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285087701Medicaid