Provider Demographics
NPI:1619696606
Name:HOPEBRIDGE LLC
Entity Type:Organization
Organization Name:HOPEBRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DICARLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-324-0885
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:6563 WILSON MILLS RD STE 102
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3409
Practice Address - Country:US
Practice Address - Phone:855-324-0885
Practice Address - Fax:317-520-8200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEBRIDGE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty