Provider Demographics
NPI:1922450253
Name:ST. HOPE COMMUNITY HEALTH CENTER CLINIC
Entity Type:Organization
Organization Name:ST. HOPE COMMUNITY HEALTH CENTER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-778-1300
Mailing Address - Street 1:1414 S. FRAZIER
Mailing Address - Street 2:SUITE#105
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-4453
Mailing Address - Country:US
Mailing Address - Phone:936-441-2440
Mailing Address - Fax:800-249-5020
Practice Address - Street 1:6200 SAVOY DRIVE
Practice Address - Street 2:SUITE#540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3338
Practice Address - Country:US
Practice Address - Phone:713-778-1300
Practice Address - Fax:713-778-0827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. HOPE FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00791XMedicare PIN