Provider Demographics
NPI:1639677198
Name:HOPEBRIDGE, LLC
Entity Type:Organization
Organization Name:HOPEBRIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-376-8336
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:765-450-6664
Practice Address - Street 1:6085 EMERALD PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3269
Practice Address - Country:US
Practice Address - Phone:855-324-0885
Practice Address - Fax:765-450-6664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEBRIDGE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-30
Last Update Date:2018-05-09
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
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0265907Medicaid