Provider Demographics
NPI:1912371063
Name:HOPE SPRINGS HEALTH LLC
Entity Type:Organization
Organization Name:HOPE SPRINGS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAMEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:541-643-1638
Mailing Address - Street 1:P.O. BOX 458
Mailing Address - Street 2:
Mailing Address - City:GLIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97443
Mailing Address - Country:US
Mailing Address - Phone:541-496-0298
Mailing Address - Fax:541-496-0703
Practice Address - Street 1:20172 NORTH UMPQUA HWY.
Practice Address - Street 2:
Practice Address - City:GLIDE
Practice Address - State:OR
Practice Address - Zip Code:97443
Practice Address - Country:US
Practice Address - Phone:541-496-0298
Practice Address - Fax:541-496-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500697442Medicaid