Provider Demographics
NPI:1861686024
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:CEO
Authorized Official - Prefix:MR
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:P.O. BOX 188
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:740-851-4674
Practice Address - Street 1:41865 POMEROY PIKE
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769
Practice Address - Country:US
Practice Address - Phone:740-773-4366
Practice Address - Fax:740-851-4674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEWELL HEALTH CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-30
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2773673Medicaid
OH0247343Medicaid
OH2773673Medicaid