Provider Demographics
NPI:1659362374
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:1950 MOUNT SAINT MARYS DR
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-1280
Practice Address - Country:US
Practice Address - Phone:740-797-2352
Practice Address - Fax:740-775-9159
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:2019-08-25
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
OH2427850Medicaid
OH0247343Medicaid
361887Medicare Oscar/Certification