Provider Demographics
NPI:1255322962
Name:HOPEWELL HEALTH CENTERS INC
Entity Type:Organization
Organization Name:HOPEWELL HEALTH CENTERS INC
Other - Org Name:FAMILY HEALTHCARE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRIDENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-773-4366
Mailing Address - Street 1:1049 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1104
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:2541 PANTHER DR
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764
Practice Address - Country:US
Practice Address - Phone:740-342-4192
Practice Address - Fax:740-342-4045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEWELL HEALTH CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-02
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0247343Medicaid
OH0836671Medicaid
=========002OtherTRICARE
OH0836671Medicaid
=========002OtherTRICARE