Provider Demographics
NPI:1558479683
Name:ST. HOPE FOUNDATION, INC.
Entity Type:Organization
Organization Name:ST. HOPE FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-778-1300
Mailing Address - Street 1:6200 SAVOY DR
Mailing Address - Street 2:SUITE 540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3338
Mailing Address - Country:US
Mailing Address - Phone:713-778-1300
Mailing Address - Fax:713-778-0827
Practice Address - Street 1:6800 WEST LOOP S
Practice Address - Street 2:SUITE 560
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4516
Practice Address - Country:US
Practice Address - Phone:713-839-7111
Practice Address - Fax:713-839-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021KKOtherBLUE CROSS/BLUE SHIELD
TX4157240-01Medicaid
TX00791XMedicare PIN
TX0021KKOtherBLUE CROSS/BLUE SHIELD