HOPEBRIDGE, LLC

Provider Demographics

• NPI: 1891820668
• Name: HOPEBRIDGE, LLC
• Entity Type: Organization
• Organization Name: HOPEBRIDGE, LLC
• Other - Org Name: HOMEFRONT LEARNING CENTER INC DBA HOPEBRIDGE PEDIATRIC SPECIALISTS
• Other - Org Type: Former Legal Business Name
• Authorized Official - Title/Position: INSURANCE & CREDENTIALING MANAGER
• Authorized Official - First Name: ANGIE
• Authorized Official - Last Name: GRAFF
• Authorized Official - Phone: 317-376-8336
• Mailing Address - Street 1: 3500 DEPAUW BLVD
• Mailing Address - Street 2: SUITE 3070
• 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: 317-763-2099
• Practice Address - Street 1: 1558 E BOULEVARD STE A
• Practice Address - City: KOKOMO
• Practice Address - State: IN
• Practice Address - Zip Code: 46902-2479
• Practice Address - Country: US
• Practice Address - Phone: 765-252-0530
• Practice Address - Fax: 317-520-8200
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-02-22
• Last Update Date: 2023-12-11

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2084P0804X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Child & Adolescent Psychiatry	Group - Multi-Specialty
No	103K00000X	Behavioral Health & Social Service Providers	Behavior Analyst		Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	106E00000X	Behavioral Health & Social Service Providers	Assistant Behavior Analyst		Group - Multi-Specialty
No	106S00000X	Behavioral Health & Social Service Providers	Behavior Technician		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	2251P0200X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist	Pediatrics	Group - Multi-Specialty
No	225X00000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist		Group - Multi-Specialty
No	225XP0200X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist	Pediatrics	Group - Multi-Specialty
No	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	000000975491	Other	ANTHEM
IN	300007183	Medicaid
IN	300007160	Medicaid
IN	200925340A-I	Medicaid
IN	300006160	Medicaid
IN	300007369	Medicaid
IN	3000013388	Medicaid
IN	300007293	Medicaid
IN	300007629	Medicaid
IN	200533240 A, C-I	Medicaid